The Kidscope Study: an analysis of a community paediatric development clinic set in a disadvantaged area of Ireland

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Date
2024
Authors
Buckley, Lynn
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University College Cork
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Abstract
Background: Set in the disadvantaged community of Cork city northwest, Kidscope is the only community paediatric development clinic in Ireland to offer assessment, care, and onward referral within a highly vulnerable area. The complex healthcare intervention provides early developmental assessment and care for children aged zero to six years. Disadvantaged communities often experience a lack of empowerment and limited engagement with services, and high-quality services for children can be inconsistent and limited. Ireland’s disjointed disability system sees children from more affluent communities access health and developmental supports faster through paid private assessment. Kidscope attempts to intercept the gap within the system by providing timely and accessible health and developmental care to vulnerable children. A detailed analysis of Kidscope and its value for supporting the health and development of a vulnerable population was warranted. Methods: Analysis of Kidscope was carried out through a retrospective mixed-methods realist evaluation examining if and how engagement with Kidscope supports the health and developmental needs of vulnerable children. ‘Context (c) + mechanism (m) = outcome (o)’ configurations explained under what contexts, for whom, and how Kidscope achieves this. Underpinned by the Ecological Systems Theory and guided by the Medical Research Council Framework for Complex Interventions, realist evaluation involved three phases: 1. Develop initial programme theories (IPTs), 2. Test IPTs, and 3. Refine programme theory. From 2019 to 2023, five studies tested and refined IPTs using multiple data sources and methods of analysis. Results were collated and analysed in a convergent approach to refine programme theory and develop a set of comprehensive findings to answer the research question. Findings: Ten IPTs were tested and refined through a systematic review of international evidence and four Kidscope-specific empirical studies: a stakeholder analysis, process evaluation, experience and meaning study, and comparison study examining models of care employed in Kidscope and a hospital-based equivalent clinic. Kidscope is set in an area of social disadvantage with higher levels of adversity and complex needs. Families encounter multiple barriers to healthcare access. A long history of community collaboration provides solid foundations for implementation, and contextual elements facilitate delivery: an accessible and welcoming space cognisant of community needs; care delivered over multiple touchpoints; and, embedded practitioner training and education. Mechanisms triggering delivery of child health and developmental support include: utilising and enhancing local expertise through Infant Mental Health (IMH) approaches; relational working; timely and coordinated health and developmental assessment, care, and onward referral; care from a range of specialists; innovative and flexible implementation processes; child and family advocacy; and bridging gaps between services and sectors. Kidscope supports the health and developmental needs of vulnerable children by 1. Developing an innovative and responsive, community-driven child and family model of care, 2. Growing a coalition of IMH-informed child development professionals, 3. Building strong relationships, 4. Meaningfully engaging vulnerable families, and 5. Tackling barriers to highquality healthcare access. Conclusions: Kidscope contributes to breaking the cycle of intergenerational poverty by disrupting the impacts of exclusion to healthcare on child development. By examining interrelationships between context, mechanisms, and outcomes using a realist lens, findings explain how engagement with Kidscope supports the health and developmental needs of a vulnerable population. National healthcare policies promising efficient developmental assessment and integrated care have yet to achieve such goals. The research offers important insights into the health needs and values of a vulnerable population that can be used to thoughtfully examine models of care within contemporary child health practices in Ireland and further afield. Findings provide evidence to support implementing similar models of care across disadvantaged areas to benefit the most vulnerable in society.
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Keywords
Child health , Child health services , Child development , Vulnerable populations , Disadvantaged community , Community health , Medical training and education , Stakeholders , Stakeholder perspectives , Community partnerships , Parent perspectives , Process evaluation , Mixed-methods , Realist evaluation
Citation
Buckley, L. 2024. The Kidscope Study: an analysis of a community paediatric development clinic set in a disadvantaged area of Ireland. PhD Thesis, University College Cork.
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