MAx Clinical Redesign
27 August 2012 Last updated:
14 October 2014
MAx Clinical Redesign Paediatric Assessment
By Carissa Louwen, Sydney Local Health District
The MAx Clinical Redesign project aims to improve clinical processes of multidisciplinary referral, intake and assessment for children with multiple risk factors and vulnerabilities, with a focus on children entering Out-of-Home Care (OOHC).
The MAx Clinical Redesign Project was initiated by the Child and Family Clinical Services directorate in early 2010. The project was brought about by the recommendations made by Justice Woods, which included a child entering Out of Home Care to undergo a comprehensive multidisciplinary assessment within 90 days of entering care if required.
At the time that these recommendations were made the Child and Family Clinical Services directorate were unable to provide a standardised comprehensive multidisciplinary assessment across the area. It was also determined that children with multiple vulnerabilities and/or difficulties requiring multidisciplinary assessments were unable to access such a service across all locations or those clinics that did exist were not providing standardised services.
The goals and objectives of the project are to:
- Develop processes and procedures for consistent and early identification of children requiring multidisciplinary services, especially those prioritised by multiple risk factors (e.g. children entering OOHC)
- Establish clearly defined multidisciplinary pathways
- Ensure equitable and timely access to an initial multidisciplinary assessment
- Develop processes and systems to monitor timeliness of access and quality of services provided
- Standardise and streamline initial multidisciplinary assessment for children entering OOHC (for example, the processes, format, assessment tools used, time, personnel, and outcomes expected) across Community Health and Sydney and South Western Sydney Local Health Districts
- Improve the assessment experience for children, their families and carers
The project utilised a Clinical Redesign approach and worked through the phases of diagnosis, solution design, implementation planning, implementation and transition, monitor and sustain.
During the diagnostic phase operational multidisciplinary clinics were consulted regarding their clinics, other expert professionals were consulted, literature searches were conducted and consultations with all staff occurred.
The solution design phase saw large working parties formed to work through possible solutions to the key issues identified during the diagnostic phase, which were grouped into:
- processes and procedures
- roles of professionals in the clinics
- reporting requirements.
During the implementation planning phase all solutions were filtered to realistic ideas and developed. Smaller working parties were formed to work on the development of processes, procedures, paperwork and other related documents for the MAx clinics prior to implementation. The implementation roll-out was also confirmed, which was based on a change readiness survey to ensure implementation was conducted at one existing site and one new site per month over five months.
The implementation training occurred the month leading up to the centres scheduled implementation month and consisted of two ½ day training sessions for new clinics and one ½ day training for existing Multidisciplinary Clinics. The implementation training consisted of:
- Background to the MAx project and project phases
- Developing a multidisciplinary view of clients
- Working collaboratively in a team
- Aim of a MAx clinic
- Pathway through a MAx clinic
- Roles of staff working in a MAx clinic
- Keyworker tasks
- Viewing different MAx documents, particularly MAx intake procedure, intake form, eligibility guidelines and flowchart, day of a MAx clinic procedures, and the MAx database
The ten initial sites for implementation were: Camperdown, Canterbury, Marrickville, Macarthur, Bowral, Croydon, Fairfield, Bankstown, Campbelltown and Liverpool.
The local teams implemented MAx clinics using the developed systems, processes, procedures and guidelines:
- MAx Pathway, which is a visual diagram representing the process of how a referral progresses. Once eligibility for MAx is established, all clients pass through this pathway regardless of the initial reason for the referral or which discipline initially took the intake information.
- Eligibility criteria and flowchart:
- child is under 8 years of age (or in Year 2 or below at school) OR under 12 years of age and entering OOHC
- referral indicates difficulties in two or more functional domains
- complexity of needs are impacting on the child's day-to-day activities and environments
- referral information indicates services are required from two or more disciplines and/or
- referral information indicates family and/or child presents with other risk factors
- Intake form and referral indicators to gather information on all functional domains
- MAx database to record referral, clinic appointments, professionals involved and discharge from MAx clinics
- Procedures and guidelines for intake, day of assessment, paperwork requirements, keyworker responsibilities, allocation meetings, discharge, and evaluation
- Paperwork, such as case history questionnaire, letters to referrers, appointment confirmation letter, report template, file audits, parent/carer survey, and monthly report template
Staff reported more time to work through the various documents, systems and processes would have been beneficial during the implementation planning phase.
A survey completed post implementation demonstrated that over 70% of participants said the implementation sessions mostly or comprehensively prepared them to complete a multidisciplinary intake.
Over 48% of participants reported the documents were easy to use, with a number of participants not having used the documents yet at the time of the survey, and less than 0.1% reported the documents were difficult to use.
12 out of the 13 possible implementation sites underwent implementation training in 2012 with the 13th site undergoing implementation training in 2013 due to staffing vacancies.
Prior to the project MAx-type clinics were being conducted at 6 sites across the area. MAx clinics are now being conducted at 11 sites across the areas, with two sites not implementing MAx due to staffing issues.
The management of MAx clinics were migrated to the Child and Family Directors once the MAx project team disbanded in April 2012. MAx facilitators have been appointed for each MAx clinic in 2012 and are responsible for the management of their local clinics and completing required reporting requirements. A MAx network is to commence in November 2012, which was one of the final recommendations, which aims to support MAx facilitators across all MAx clinic sites and work through any issues that may arise post-implementation.
Speech Pathology Head of Department, Child and Family Clinical Services
Camperdown Community Health Centre, 142 Carillon Rd, Camperdown NSW 2050
Phone: 02 9516 3232
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