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Partnerships for Children (HARP)

RCH > Medical Services > Ambulatory Services > Partnerships for Children (HARP)

 

Programs

 

'Partnerships for Children Program' has five (5) HARP-CDM funded streams operating:

 

Accelerated Care through Emergency (ACE)

This program is available to any child or young person who because of their complex care needs (medical and/or psychosocial) either frequently present to RCH or are likely to frequently present. ACE is available statewide as long as the majority of care occurs at RCH.

ACE provides care coordination and 24 hour phone support for children, young people and their families and aims to assist them in managing their child at home or fast tracking presentation/admission to RCH if required.

ACE's highly skilled Care Coordinators work with other specialist treating teams to support and provide education to families about the care needs for their child/young person. Care Coordinators are based in the hospital during business hours (0700-1800 Monday to Friday) and are on-call after hours and on weekends. Each Care Coordinator always has access to information pertaining to each child's; history, primary medical practitioners, contact details and an up-to-date emergency care plan.

 

Program Aim

The aim of the Program is to reduce avoidable use of acute services (hospitals and emergency departments) by providing an experienced nursing support to a group of children living with multiple complex medical needs who are expected to access the hospital on a frequent basis. These nurses are highly experienced and provide care coordination for the child and their family, in by being available 24 hours per day, seven days per week.  The team develops care plans in conjunction with the multiple treating teams and the families, and follow this plan when a family contact the service.  The team member on duty will discuss the issue/s with the family and based on their knowledge of the child's condition and the details in the care plan, will i) provide advice and action plan for the carer; ii) contact the relevant consultant and seek advice or iii) advise the family to make their way to the ED for further investigation / treatment.

Another key aspect to the program is to accelerate a child/young person's presentation (and if necessary admission to RCH) by providing support to 'fast-track' them through the RCH system.

 

Eligibility

ACE Admission criteria:

  • A child or young person with complex chronic care needs (medical and psychosocial) who is managed by multiple units within RCH.
  • A history of multiple presentations to the RCH emergency department (4 or more in the last 12 months).
  • A child or young person who has experienced a recent change in circumstances which means that they are likely to frequently present to the RCH Emergency Department.

 

Each child/young person is assessed on an individual basis and when deemed eligible their parents/carers are contacted and detailed information about ACE program is provided. The referrer (if not the parent / carer) will also receive written confirmation that the child/young person has been accepted onto the ACE program.

If a referral is deemed ineligible, then the referrer and family are notified, and the child/young person's status is reviewed in three (3) months time. A referral will remain in the review process for one year.

 

Referral Process

Referrals can be made by consultants, medical staff, nursing staff, allied health professionals, community carers, community doctors, or parents/carers.

Referrals should be made on the form below and faxed to: 9345 6976 or posted to:

ACE Program

c/o Emergency Department,
Royal Children's Hospital,
Flemington Road,
Parkville
3052.

If you wish to be notified when your referral is received please note this on the referral form.

 

 

Contact us

ACE Office Tel: 9345 6159

Office Hours: 0700 to 1800 Monday to Friday

On call 24 hour service: 0409 882 197


Page: 9345 5522 pager 6159

Fax: 9345 6976


Email: ace.program@rch.org.au

 

Program Staff

Kerryn Williams -Nurse Care Coordinator

David Sutton -Nurse Care Coordinator

Melanie Zan -Nurse Care Coordinator

Michelle Annal -Nurse Care Coordinator

Lisa Carmody -Nurse Care Coordinator

 

Links

RCH Emergency Department Website

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Community Asthma Program (CAP)

Program Aim

CAP aims to reduce avoidable use of acute services while improving the morbidity indicators of children and parents with asthma by providing enhanced primary care through community-based services. The program focuses on provision of co-ordinated, responsive, preventative services, based in the community, with a focus upon asthma self-management and improved cohesion of services for children and young people presenting with asthma symptoms.

 

Eligibility

Children and young people (0-18 years) presenting to the Royal Children's Hospital with a diagnosis of asthma. Families must live in postcodes 3000-3099 or the Cities of Boroondara, Stonington, Port Phillip or Yarra.

Referrals must meet HARP-CDM eligibility. This means that children are frequently presenting to hospital with asthma or at risk of hospital presentation due to the complexity of their chronic illness and other social or medical reasons.

Ineligible children may be referred to other health professionals or agencies, with the appropriate consent from the family.

CAP respects the needs of different languages and is able to link with interpreting services, if needed at no cost.

 

Service

Highly skilled asthma educators provide free asthma education and support to young people, their families and other key people (ie children's services, school staff etc) to better understand asthma and ways to better manage when symptoms appear.
An Asthma Educator can visit children and their family at home, in the GP surgery, or at another location convenient to them.

 

Referral Process

The following referral sources are accepted: medical and nursing staff, self-referrals, GP and maternal and child health.

 

Contact us

Jan Gregor

RCH Support Nurse

Community Asthma Program


Tel: 03 9345 5295 or 03 9345 5522 pager# 5295

 

Program Staff


Craig Moore - CAP Program Manager - Dianella Community Health

Michelle Norman - CAP Liaison Coordinator - Doutta Galla Community Health

Jan Gregor- Support Nurse - RCH

Jacqui Piko - Asthma Educator - Doutta Galla & North Yarra Community Health

Jeanette Jarvis - Asthma Educator - Dianella Community Health

Jane Eddy - Asthma Educator -Darebin Community Health

Janelle Port - Asthma Educator - Doutta Galla Community Health

Emma Tarquinio - Asthma Educator -North Yarra Community Health

Brooke Thompson - Asthma Educator -Doutta Galla & North Yarra Community Health

Roslyn Scholz - Asthma Educator -North Yarra Community Health

Sheryll Coulston -Asthma Educator -Doutta Galla Community Health

 

Administration Assistant - Dianella Community Health

 

Links

RCH Emergency Department Website

CAP at Dianella Community Health Service

Asthma Foundation of Victoria:www.asthma.org.au

 

 

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Diabetes Allied Health Service (DAHT)

The Diabetes Allied Health Team is a joint program supported by Partnerships for Children and the Department of Endocrinology. The team provide education and support to any RCH patient with diabetes (type 1 or 2).   This support includes but is not limited to:

  • Newly diagnosed diabetes
  • Insulin Pump Management
  • Sick Day Management
  • Dietary Education
  • Psychosocial Support
  • Continuous Glucose Monitoring

The service operates in an 'ambulatory' manner, which means that young people and their families are not admitted as inpatients, but rather access health professionals in the hospital for daily programs or appointments as instructed.

Partnerships for Children support focuses on children and young people who because of their diabetes are assessed as being at risk of admission either due to medical instability or psychosocial issues. There are 2 types of support offered:

  • Ambulatory Stabilisation - intense ambulatory education for newly diagnosed patients instead of traditional inpatient care.
  • Allied Health Clinic - extended 1 hour appointments with Dietician, Social Work and Diabetes Nurse Educators.

The Diabetes Allied Health Team is a multi-disciplinary consisting of Diabetes Nurse Educators; Social Workers; Dieticians;  Medical Specialists and Admin Support. 

 

Program Aim

The aim of the Diabetes Allied Health Team is to support young people and their families living with Diabetes through education and support, to improve outcomes and the quality of life for all involved.

 

Eligibility

Any young person diagnosed with Diabetes (type 1 or 2) can be referred to the Diabetes Allied Health Team. Newly diagnosed, and those with existing conditions requiring additional support, education and advice can contact the team as required.

A member of the team will assess the young person once a referral is received to determine appropriateness for service, and then work collaboratively with the other disciplines within the team to ensure relevant health and social needs are been addressed.

 

Service

The Allied Health Service is a multi-disciplinary team consisting of 5.5 EFT Diabetes Nurse Educators; 1.5 EFT Social Work; 2.0 EFT Dietitians; 1.0 EFT Admin.  We are currently recruiting 1.0 EFT medical specialist to join the team.

Young people identified as being 'at risk' of presenting to the ED will be referred to the service, which will enable higher level of intervention to take place, with the aim of preventing a presentation to the ED.

The service works in an 'ambulatory' manner, which means that young people and their families are not admitted as inpatients, but rather access health professionals in the hospital for daily programs or appointments as instructed.

 

Referral Process

Referrals can be made by hospital or community based individuals including but not limited to; GP's, Paediatrician's, Patients, Families and RCH staff.

To refer please complete the form below and fax to the Diabetes Allied Health Team on 03 9345 4380

 

 

Contact us

Diabetes Department

Tel: 03 9345 6661

Fax: 039345 4380

After hours please contact RCH Switch on 03 9345 5522 and ask for the Diabetes After Hours Service.

RCH Diabetes Website

 

Program Staff

Andrew Boucher- Diabetes Nurse Educator

Rebecca Gebert- Diabetes Nurse Educator

Rebecca Humphreys- Diabetes Nurse Educator

Eliza Bourke- Diabetes Nurse Educator

Lauren Foulds- Diabetes Nurse Educator

Kathryn Hamilton- Diabetes Nurse Educator

Catherine Prochilo- Diabetes Nurse Educator

Elisha Matthews- Dietician

Heather Gilbertson -Dietician

Jana Fugaro- Social Worker

Jessica Drabkin- Social Worker

 

Anita Antunivicspehar - Administration

Veronica Villena- Administration

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Social Work in the Emergency Department (SWED)

Program Aim

The program provides psychosocial and social support to patients and their families presenting to the emergency department who are experiencing a crisis or trauma or who have psychosocial issues or are at risk.  The service provides assessment, short-term therapeutic and educational support and arranges access to hospital and community based services.  

Services are developmentally appropriate, family centred, solution focused and strength based.   Staff use a social model of health that focuses on the interaction between child, caregiver and environment.

Intervention includes crisis intervention, counselling, parenting education and support, child and family therapy, admission and discharge planning, advocacy and referral to community services.

There are two service streams provided in an integrated and coordinated way within the team:

1. General Service

The general Social Work service provides support to children and families in crisis due to trauma, new diagnosis or bereavement; or due to other family, personal concerns or environmental factors.  Staff also provide emergency welfare support through assistance with accessing practical resources and assist people to adjust to the hospital system.

The aim is to minimize the impact of the trauma or crisis and maximize child and family recovery and reconnection. 

2. HARP

The HARP stream provides interventions to people with psychosocial issues and aims to reduce avoidable hospitalization, improve family functioning and support and increase both children's and parents ability to self manage.  Psychosocial issues can either be the primary reason for frequent presentation to hospital or can be a compounding factor for an individual with chronic health care needs.

Intervention commences in the ED, so as to support early discharge where appropriate and where possible reduce length of stay in the ED and / or the hospital.

 

Eligibility

Referrers make a referral to the program generally and do not need to specify a particular stream. Social work staff determine the relevant stream and HARP eligibility through a HARP eligibility tool specifically developed for the program.  Priority is given to HARP referrals and to situations where psychological trauma requires an immediate response.

 

Service

The team consists of Five (5) highly skilled Social Workers who provide a seven (7) days a week service. The service is available between 8:00am - 10:00pm Weekdays and 2:00pm - 10:00pm weekends.

 

Referral Process

Referral can be made by any of the clinicians within the Emergency Department, directly to a Social Worker on duty.  After hours referrals are made through a referral system.

 

 

Contact us

Social Work in the Emergency Department
Tel: +61 3 9345 4914

RCH Emergency Department Website

 

Staff

Julie Langdon - Social Worker & Team Leader

Penny Moody - Social Worker

Jenny Conrick - Social Worker

Ronda Johns - Social Worker

 

 

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Eczema Project (ECZ)

This Eczema Project is a 12 month trial of community based nurse-led eczema clinics at North Yarra and Doutta Galla Community Health Services.

These clinics will provide comprehensive assessment, education and care coordination for children and young people with complex eczema and their family's. Medical support will be provided by the GP staff located at the Community Health Centres with additional support from the Dermatology Department at the RCH. Patients and families will be linked into additional community health service supports as necessary which could include dietician, social worker, psychologist etc. Where necessary additional education and support will be provided to agencies with which the patient is involved such as kindergartens, child care centres and schools.

 

Program Aim

The aims of this project are to:

  • Improve the ability of families to manage their child/young person's eczema by providing appropriate knowledge and skills.
  • Improve the quality of life of children, young people with eczema and their families by providing the knowledge and skills to effectively mange their eczema.
  • Reduce the length of time children and young people are waiting for existing Eczema support.
  • Stream line the appointment process for eligible patients presenting to the RCH Emergency Department.
  • Reduce the number of eczema related inpatient admissions at RCH.

 

Eligibility

As this is a trial project child/young person must reside within postcodes: 3000-3099.

Eligibility is based on complexity as assessed by the following criteria

  • Child/young person presenting to RCH with a SCORAD of 30 or greater, or
  • Child/young person with one or more presentations, to the RCH emergency department over a 12 month period, or
  • Child/young person requiring one or more admission to RCH due to their eczema in a 12 month period, or
  • Child/young person from a CALD (Culturally and Linguistically Diverse)background who is unable to access existing eczema education and support programs, or
  • Child/young person/family with psychosocial issues impacting on their ability to manage their home treatment plan and impeding self management, or
  • Any other child/young person assessed by the RCH Dermatology or General Paediatric teams as being at imminent risk of admission to the RCH in relation to their eczema.

Each child/young person is assessed on an individual basis and when deemed eligible their parents/carers are contacted and details about the program and an appointment time/day are provided.

Where necessary, interpreters are involved to assist families from non-English speaking backgrounds.

If the patient is deemed not eligible for involvement in the project then the patient will be referred to the RCH Dermatology Department.

If the patient is enrolled in the project and requires further assistance from the RCH Dermatology Department a referral and prompt appointment will be made.

 

Service

Workshop Times from:

  • New Patient Clinic (AM) 0915-1230
  • Review Patient Clinic (PM) 1330-1630

Community Centres

  • Every Monday at North Yarra Community Health Service ,

         365 Hoddle Street Collingwood, 9411 4333.

A map for the location of the Community Centre can be found through the link below:

http://www.nych.org.au/location/collingwood.html

Public Transport

Train: Epping or Hurstbridge Train lines - Victoria Park station

Buses:

200 - City - Doncaster Shoppingtown via Bulleen

201 - City - Doncaster Shoppingtown via Belmore Road

203 - City - Doncaster Shoppingtown via Eastern Freeway

205 - Melbourne University - Doncaster Shoppingtown via Kew Junction

207 - City - Donvale via Doncaster Road

246 - Elsternwick - La Trobe University via Clifton Hill, St Kilda Junction

301 - City - The Pines SC via Templestowe, Freeway

313 - City (Russell Street) - Templestowe via Eastern Freeway, Kilby Road

316 - City (Russell Street) - Deep Creek via Eastern Freeway, Doncaster Road

340 - City - La Trobe University via Freeway

315 - City (Russell Street) - Box Hill via Eastern Freeway, Greythorn Road

319 - City - The Pines via King Street (Freeway Exp)

350 - City - La Trobe University via Freeway (Limited Pick Up and Set Down)

 

 

  • Every Thursday at Doutta Galla Community Health Service ,

         12 Gower Street Kensington, 8378 1600.

A map for the location of the Community Centre can be found through the link below:

http://www.doutta.org.au/www/384/1002113/displayarticle/locations--1002171.html

Public Transport

Train: Craigieburn Train line - Kensington Station

Bus: 402 - Footscray - East Melbourne via North Melbourne

 

Referral Process

Referrals can be made by hospital or community based individuals including but not limited to; GP's, Paediatrician's and emergency department staff.

As this is a trial project there are eligibility criteria and the child/young person must reside within postcodes: 3000-3099.

Referrals are made by completing the referral from linked below and faxing it to 03 9345 6231.

Referrals will be accepted in VSRF format but must address eligibility criteria listed above.

 The referral requests a SCORAD Evaluation. For information on how to calculate SCORAD please follow the link below:

Contact us

Eczema Project Nurses

Monday and Thursdays

9345 5522 pager# 5382

eczema_nurse@rch.org.au

 

Booking Enquiries

Michelle Devlin

Partnerships for Children

Royal Children's Hospital

9345 5972


Information about the Project

Katie Williams

Manager Partnerships for Children

Royal Children's Hospital

9345 6146

 

Project Staff

Leigh Fitzsimons - Eczema Project Nurse - North Yarra Community Health Service

Louise Payne - Eczema Project Nurse - Doutta Galla Community Health Service

 

Emma King - Paediatric Eczema Nurse Practitioner - Royal Children's Hospital

 

Links

RCH Dermatology Department

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Last Updated 07-Sep-2009. Authorised by: Nicole Kondogiannis. Enquiries: Nicole Kondogiannis.
webmaster. © RCH.