Training Intervention and Program of Support (TIPS) for Fostering the Adoption of Family-centred Telehealth Interventions in Pediatric Rehabilitation: A Pan-Canadian Implementation-effectiveness Study
Trial Snapshot
- Phase
- Not Applicable
- Status
- Recruiting
- Sponsor
- Université de Sherbrooke
- Enrollment
- 2,360
- Locations
- 3
- Primary Endpoint
- TIPS Therapist Champion Survey
Study Overview
Brief Summary
Timely access to family-centred services for children with disability and their families is important to support their development and well-being. Currently, many children face long wait times and barriers to services. Lack of access can lead to negative impacts for children and stress for their families. With the COVID-19 pandemic, these issues have been made more challenging with the loss of rehabilitation support for children, increasing stress on families. During this time, therapists moved to telehealth service delivery to support children and families.
We know that telehealth can improve access to services, children's outcomes, and family satisfaction, and that telehealth a key element of Family Centred Services (FCS) in pediatric rehabilitation. FCC include practices that promote flexibility, respect and dignity for families' views, knowledge and strengths, effective information sharing, partnership and collaboration in decision making, and coordinated and comprehensive care. FCC focuses on developing collaborative family-provider relationships, where parents are active participants in collaborative goal-setting, therapy planning, implementation, and evaluation, and where activities are integrated within daily routines and contexts (e.g., home and community). Compared to traditional service delivery methods, telehealth offers opportunities to enhance FCC practices. FCC provides alternate, convenient, and flexible ways to partner with families, respecting their characteristics and barriers, allows knowledge and information sharing about the child within their contexts, supports family decision making and parents' well-being, and has been recognized as an important addition to comprehensive care coordination and service delivery.
Telehealth is an important and effective alternative for families living in both urban and remote or underserved areas and can be more convenient than in-person visits (e.g., less travel time, schedule flexibility). However, the use of telehealth prior to the pandemic was low in pediatric rehabilitation. In addition, many therapists report delivering telehealth without prior experience, and lack confidence, knowledge, and training in effective intervention strategies. Although therapists' knowledge, skills and attitudes toward telehealth can improve with time and experience, training and support are required for behavioural changes to occur.
Following the pandemic, there has been continued support for the use of FCT and for its ongoing use to support families of children with disability. Pediatric rehabilitation therapists, service managers, professional associations, policy makers, and families are all making the case for not "returning to normal", and are asking for help to keep telehealth as part of FCS care.
The goal of the current study is to evaluate the use and effectiveness of a Training Intervention and Program of Support (TIPS) to increase the uptake of FCT in pediatric rehabilitation centres across Canada.
The main research question is: Can TIPS be adapted to increase the use of FCT interventions by therapists working in different contexts?
The primary objectives are to:
-
Evaluate the use of FCT regarding:
-
Therapists' desire to use vs actual use of FCT practices
-
Use of FCT practices as they were intended to be used
Secondary objectives are to: 2. Describe the variations required to adapt the TIPS to meet each site's needs 3. Identify factors that influence FCT use and adherence 4. Evaluate the effectiveness with regards to:
- Service wait-times
- Family-centredness of services
- Changes in service delivery
- Evaluate the costs (and possible cost savings) related to increased use of FCT
The primary hypotheses are that therapists' desire to adopt FCT and deliver FCT practices as intended will (i) improve slightly in the short term (i.e., one-month post-TIPS), yet (ii) will improve significantly post-TIPS, (iii) while actual use will vary over time, across sites and therapists, and will depend on therapist-, client-, organizational- and system-factors. For the secondary hypotheses, the investigators expect that, for sites with the largest changes in desire to use and use of FCT practices as intended, (iv) wait times will significantly decrease and (v) families' perceptions of service quality will significantly improve post-TIPS.
Detailed Description
INTRODUCTION Timely access to family-centred services for children with disability and their families is crucial to support their development and well-being. Currently, many children face long wait times (i.e., up to 2 years) and organizational, geographic and/or cultural barriers to services. Lack of access can lead to negative developmental, health and social consequences for children (e.g., suboptimal development, academic difficulties) and their families (e.g., stress). The COVID-19 pandemic further exacerbated these issues, as rehabilitation support for children was lost, increasing parental mental health burden (e.g., increased stress, depression). To minimize the negative impacts of these service disruptions, therapists were required to shift to telehealth service delivery.
Evidence exists of the efficacy of telehealth to improve service access, children's outcomes, and family satisfaction and acceptability, supporting the integration of telehealth as a key element of Family Centred Services (FCS) in pediatric rehabilitation. Telehealth can be defined as 'any asynchronous or real time clinical intervention provided remotely by therapists to patients and/or caregivers. It has been recognized as an important alternative for families living in underserved or remote areas. However, some families in well-served urban locations also prefer the convenience of telehealth over in-person visits (e.g., less travel time, schedule flexibility). Prior to the pandemic, a systematic review of pediatric rehabilitation telehealth randomized controlled trials supported the efficacy of such interventions for a wide range of outcomes and diverse populations. Further publications demonstrated the efficacy and acceptability of telehealth, further supporting its integration into comprehensive FCS models.
The established efficacy of telehealth highlights a critical knowledge-to-practice gap. Before the pandemic, the adoption of telehealth was low in pediatric rehabilitation. In an international survey conducted in August 2019 (1,133 pediatric therapists from 76 countries), 3.9% were using telehealth; a follow-up survey with a subsample in May 2020 highlighted that 70.1% had adopted telehealth. Many reported doing so without prior experience, and lacked confidence, knowledge, and training in effective intervention strategies. When asked what support was required to implement telehealth, training was by far the most frequently cited - and included communication skills with families over the phone and internet, safe and effective use of platforms, reliable assessment, and intervention strategies with children of various ages and health conditions. Although therapists' knowledge, skills and attitudes toward telehealth can improve with time and experience, training and support are required for behavioural changes to occur. Unfortunately, there is a paucity of evidence related to how personal and contextual factors may influence telehealth training and support. Targeting therapists' knowledge, skills, and attitudes, associated with their intention to adopt telehealth, and their professional role within FCS, appear vital to the implementation of telehealth.
For the purposes of this study, family-centred telehealth (FCT) is defined as pediatric rehabilitation which uses family-centred care (FCC) practices while working with families remotely. FCC is recognized as a best practice approach in pediatric rehabilitation. Described as a partnership approach, FCC is based on the belief that the child's well-being and care needs are best supported within the family context through effective family-provider collaborations. Moreover, FCC's central tenet is the assumption that the processes of care delivery are as important to the child and family outcomes as the specific characteristic of the clinical intervention delivered. It is characterized by practices that promote clinical flexibility, respect and dignity for families' perspectives, knowledge, strengths and characteristics, effective information sharing (general and specific), partnership and collaboration between parties to support decision making, and coordinated and comprehensive care delivery. Furthermore, FCC occurs in the therapeutic environment that optimizes the development of a collaborative family-provider relationship, where parents are active participants in collaborative goal-setting, therapy planning, implementation, and evaluation, and where activities are integrated within daily routines and contexts (e.g., home and community). Compared to more traditional service delivery methods, telehealth offers opportunities to enhance FCC practices. It provides alternate, convenient, and flexible ways to partner with families, respecting their characteristics (e.g., single parenting) and constraints (e.g., geographical, temporal, financial), allows real-time knowledge acquisition and information sharing about the child within their contexts, supports family decision making and parents' psychosocial well-being (i.e., decreasing anxiety, stress, and depression), and has been recognized as an important addition to comprehensive care coordination and service delivery.
Considerable momentum exists supporting the uptake of FCT and fostering its ongoing sustainable use within accessible and supportive services for the families of children with disability following the pandemic. Pediatric rehabilitation therapists, service managers, professional associations, policy makers, and patients alike are calling for resistance to "returning to normal", and instead are requesting help to sustain telehealth as part of the FCS continuum of care. The proposed study aims to evaluate the implementation and effectiveness of a Training Intervention and Program of Support (TIPS) to enhance the adoption of FCT in pediatric rehabilitation centres across Canada.
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- Not provided
Exclusion Criteria
- •Person responsible for rehabilitation services at the site, or their delegate
- •Therapists:
- •PTs, OTs, SLPs providing outpatient pediatric rehabilitation services to children aged 0-12 years in each site, recruited via the managers and interested in utilizing FCT
- •Parents or caregivers who received services (either in-person, virtually, or both) from at least one participating therapist in the previous 3 months
- •Therapist champion:
- •Therapist selected based on their telehealth experience and on peer recognition within their organization.
- •Parent/patient-partners:
- •Recruited from family, parent or patient advisory committees at the participating sites or, in the absence of such initiatives, from regional, provincial, or national patient engagement programs.
- •Can speak French or English
Arms & Interventions
Telehealth
The proposed pre-post study will evaluate the implementation and effectiveness of a Training Intervention and Program of Support (TIPS) to enhance the adoption of family-centred telehealth in pediatric rehabilitation centres across Canada. TIPS is a multifaceted intervention, comprised of the following: 1) a 10-hour intensive training program offered to participating therapists at each site over a one-month period, including 4 hours of self-paced learning modules and a 6-hour mandatory interactive webinar; and 2) an 11-month program of support which is composed of monthly mentoring meetings at each site led by the local therapist champion, and a national virtual community of practice facilitated by 3 national knowledge brokers - an occupational therapist, a physiotherapist and a speech-language pathologist - experienced in family-centred telehealth in pediatric rehabilitation, offered simultaneously to all participating therapists across Canada.
Intervention: Training Intervention and Program of Support (TIPS) for fostering the adoption of family-centred telehealth interventions in pediatric rehabilitation (Behavioral)
Outcomes
Primary Outcomes
TIPS Therapist Champion Survey
Time Frame: once, 2 months prior to TIPS implementation
This one-time survey is limited to the participant's sociodemographic information (e.g., discipline, years of experience), as well as their telerehabilitation experience, expertise, and training.
TIPS Therapist Survey-3
Time Frame: 1 month prior to TIPS implementation
The TIPS Therapist Survey contains sociodemographic information about the study participant (e.g., discipline, site, province, age), as well as the Therapists' Implementation Questionnaire (TIQ). The TIQ includes the ACCEPT-VFCC (Assessment of Competencies and Contributors to Enhance Practice Transition to Virtual Family Centred Care), a newly created tool inspired by the ADOPT-VR, yet specifically designed for telerehabilitation, the Family Centered Telerehabilitation (FCT) fidelity self-perceived checklist and the PRIME-SP (Pediatric Rehabilitation Intervention Measure of Engagement - Service Provider version).
TIPS Therapist Survey-1
Time Frame: 3 months prior to TIPS implementation
The TIPS Therapist Survey contains sociodemographic information about the study participant (e.g., discipline, site, province, age), as well as the Therapists' Implementation Questionnaire (TIQ). The TIQ includes the ACCEPT-VFCC (Assessment of Competencies and Contributors to Enhance Practice Transition to Virtual Family Centred Care), a newly created tool inspired by the ADOPT-VR, yet specifically designed for telerehabilitation, the Family Centered Telerehabilitation (FCT) fidelity self-perceived checklist and the PRIME-SP (Pediatric Rehabilitation Intervention Measure of Engagement - Service Provider version).
TIPS Therapist Survey-2
Time Frame: 2 months prior to TIPS implementation
The TIPS Therapist Survey contains sociodemographic information about the study participant (e.g., discipline, site, province, age), as well as the Therapists' Implementation Questionnaire (TIQ). The TIQ includes the ACCEPT-VFCC (Assessment of Competencies and Contributors to Enhance Practice Transition to Virtual Family Centred Care), a newly created tool inspired by the ADOPT-VR, yet specifically designed for telerehabilitation, the Family Centered Telerehabilitation (FCT) fidelity self-perceived checklist and the PRIME-SP (Pediatric Rehabilitation Intervention Measure of Engagement - Service Provider version).
TIPS Therapist Survey-5
Time Frame: 1 month post TIPS commencement
The TIPS Therapist Survey contains sociodemographic information about the study participant (e.g., discipline, site, province, age), as well as the Therapists' Implementation Questionnaire (TIQ). The TIQ includes the ACCEPT-VFCC (Assessment of Competencies and Contributors to Enhance Practice Transition to Virtual Family Centred Care), a newly created tool inspired by the ADOPT-VR, yet specifically designed for telerehabilitation, the Family Centered Telerehabilitation (FCT) fidelity self-perceived checklist and the PRIME-SP (Pediatric Rehabilitation Intervention Measure of Engagement - Service Provider version).
TIPS Therapist Survey-6
Time Frame: 4 months post TIPS commencement
The TIPS Therapist Survey contains sociodemographic information about the study participant (e.g., discipline, site, province, age), as well as the Therapists' Implementation Questionnaire (TIQ). The TIQ includes the ACCEPT-VFCC (Assessment of Competencies and Contributors to Enhance Practice Transition to Virtual Family Centred Care), a newly created tool inspired by the ADOPT-VR, yet specifically designed for telerehabilitation, the Family Centered Telerehabilitation (FCT) fidelity self-perceived checklist and the PRIME-SP (Pediatric Rehabilitation Intervention Measure of Engagement - Service Provider version).
TIPS Therapist Survey-8
Time Frame: 12 months post TIPS commencement
The TIPS Therapist Survey contains sociodemographic information about the study participant (e.g., discipline, site, province, age), as well as the Therapists' Implementation Questionnaire (TIQ). The TIQ includes the ACCEPT-VFCC (Assessment of Competencies and Contributors to Enhance Practice Transition to Virtual Family Centred Care), a newly created tool inspired by the ADOPT-VR, yet specifically designed for telerehabilitation, the Family Centered Telerehabilitation (FCT) fidelity self-perceived checklist and the PRIME-SP (Pediatric Rehabilitation Intervention Measure of Engagement - Service Provider version).
TIPS Therapist Survey-10
Time Frame: 6 months following the end of TIPS implementation
The TIPS Therapist Survey contains sociodemographic information about the study participant (e.g., discipline, site, province, age), as well as the Therapists' Implementation Questionnaire (TIQ). The TIQ includes the ACCEPT-VFCC (Assessment of Competencies and Contributors to Enhance Practice Transition to Virtual Family Centred Care), a newly created tool inspired by the ADOPT-VR, yet specifically designed for telerehabilitation, the Family Centered Telerehabilitation (FCT) fidelity self-perceived checklist and the PRIME-SP (Pediatric Rehabilitation Intervention Measure of Engagement - Service Provider version).
TIPS Manager Survey (Pre-Implementation)-1
Time Frame: 3 months prior to the commencement of TIPS implementation
This survey includes sociodemographic information about the manager (e.g., academic degree, discipline, years of experience), the site profile (SPQ) which includes characteristics about the services provided, the organizations e-readiness, and service wait-time indicators.
TIPS Therapist Survey-4
Time Frame: on day 1 of TIPS implementation
The TIPS Therapist Survey contains sociodemographic information about the study participant (e.g., discipline, site, province, age), as well as the Therapists' Implementation Questionnaire (TIQ). The TIQ includes the ACCEPT-VFCC (Assessment of Competencies and Contributors to Enhance Practice Transition to Virtual Family Centred Care), a newly created tool inspired by the ADOPT-VR, yet specifically designed for telerehabilitation, the Family Centered Telerehabilitation (FCT) fidelity self-perceived checklist and the PRIME-SP (Pediatric Rehabilitation Intervention Measure of Engagement - Service Provider version).
TIPS Therapist Survey-7
Time Frame: 8 months post TIPS commencement
The TIPS Therapist Survey contains sociodemographic information about the study participant (e.g., discipline, site, province, age), as well as the Therapists' Implementation Questionnaire (TIQ). The TIQ includes the ACCEPT-VFCC (Assessment of Competencies and Contributors to Enhance Practice Transition to Virtual Family Centred Care), a newly created tool inspired by the ADOPT-VR, yet specifically designed for telerehabilitation, the Family Centered Telerehabilitation (FCT) fidelity self-perceived checklist and the PRIME-SP (Pediatric Rehabilitation Intervention Measure of Engagement - Service Provider version).
TIPS Therapist Survey-9
Time Frame: 3 months following the end of TIPS implementation
The TIPS Therapist Survey contains sociodemographic information about the study participant (e.g., discipline, site, province, age), as well as the Therapists' Implementation Questionnaire (TIQ). The TIQ includes the ACCEPT-VFCC (Assessment of Competencies and Contributors to Enhance Practice Transition to Virtual Family Centred Care), a newly created tool inspired by the ADOPT-VR, yet specifically designed for telerehabilitation, the Family Centered Telerehabilitation (FCT) fidelity self-perceived checklist and the PRIME-SP (Pediatric Rehabilitation Intervention Measure of Engagement - Service Provider version).
TIPS Manager Survey (Post-Implementation)
Time Frame: within 6 months following the end of TIPS implementation
This survey includes sociodemographic information about the manager (e.g., academic degree, discipline, years of experience), the site profile (SPQ) which includes characteristics about the services provided, the organizational e-readiness, service wait-time indicators, as well as the addition of organizational costs.
TIPS Parent Survey-1
Time Frame: once, prior to day 1 of TIPS implementation
This questionnaire contains The Family Questionnaire (Fam-Q) which collects sociodemographic information about the parent participants and their family (e.g., age, household income, family structure, remoteness) and the family costs and savings associated with accessing rehabilitation services, as well as the MPOC-20 (Measure of Process of Care - 20 questions).
TIPS Parent Survey-2
Time Frame: once, within 6 months of the end of TIPS implementation
This questionnaire contains The Family Questionnaire (Fam-Q) which collects sociodemographic information about the parent participants and their family (e.g., age, household income, family structure, remoteness) and the family costs and savings associated with accessing rehabilitation services, as well as the MPOC-20 (Measure of Process of Care - 20 questions).
Semi-Structured Interviews
Time Frame: within 6 months following the end of TIPS implementation
To explore all changes in service delivery (both negative and positive), stakeholders will be invited to participate in a video-recorded semi-structured interview post-implementation. The samples will include all managers, a sample of therapists (all local site champions and a subsample of therapists showing high or low adoption in different sites); and parents with diverse sociocultural characteristics and levels of perception of quality of care and experience with FCT. Parent, manager, therapist and therapist champion interviews will all be conducted only once with each participant.
TIPS Manager Survey (Pre-Implementation)-2
Time Frame: on day 1 of TIPS implementation
This survey includes sociodemographic information about the manager (e.g., academic degree, discipline, years of experience), the site profile (SPQ) which includes characteristics about the services provided, the organizations e-readiness, and service wait-time indicators.
TIPS Parent Partner Survey
Time Frame: once, 2 months prior to TIPS implementation
This one-time survey is limited to the participant's sociodemographic characteristics (e.g., age, household income), their comfort level with technology, and their experiences with the site and the various service options (including telerehabilitation)
Secondary Outcomes
- TIPS Logic Model(within 2 months prior to commencement of TIPS implementation)
- Monthly therapist mentoring meetings(recorded at the frequency at which they occur (i.e., monthly) throughout the 11-months of the study in which they are scheduled)
- Virtual community of practice discussion threads and posts(collected regularly (i.e. monthly) over the 11 months of the support program)
Investigators
Chantal Camden
Dr. Chantal Camden
Université de Sherbrooke