How can we improve specialist health services for children with multi-referrals? Parent reported experience

Children with combined mental and somatic conditions pose a challenge to specialized health services. These cases are often characterized by multi-referrals, frequent use of health services, poor clinical and cost effectiveness, and a lack of coordination and consistency in the care. Reorganizing the health services offered to these children seems warranted. Patient reported experiences give important evidence for evaluating and developing health services. The aim of the present descriptive study was to explore how to improve specialist health services for children with multiple referrals for somatic and mental health conditions. Based on parent reported experiences of health services, we attempted to identify key areas of improvement.

As part of a larger, ongoing project; "Transitioning patients' Trajectories", we asked parents of children with multiple referrals to both somatic and mental health departments to provide their experiences with the services their children received. Parents/guardians of 250 children aged 6-12 years with multi-referrals to the Departments of Pediatrics and Child and Adolescent Mental Health at Haukeland University Hospital between 2013 and 2015 were invited. Their experience was collected through a 14 items questionnaire based on a generic questionnaire supplied with questions from parents and health personnel. Possible associations between overall experience and possible predictors were analyzed using bivariate regression.

Of the 250 parents invited, 148 (59%) responded. Mean scores on single items ranged from 3.18 to 4.42 on a 1-5 scale, where five is the best possible experience. In the multiple regression model, perception of wait time (r = .56, CI = .44-.69 / β = 0.16, CI = .05-.28), accommodation of consultations (r = .71, CI = .62-.80 / β = 0.25, CI = .06-.45 / β = 0.27, CI = .09-.44), providing adequate information about the following treatment (r = .66, CI = .55-.77 / β = 0.26, CI = .09-.43), and collaboration between different departments at the hospital (r = .68, CI = .57-.78 / β = 0.20, CI = -.01-.40) were all statistically significantly associated with parents overall experience of care.

The study support tailored interdisciplinary innovations targeting wait time, accommodation of consultations, communication regarding the following treatment and collaboration within specialist health services for children with multi-referrals to somatic and mental specialist health care services.