Consistent Quality Care
The objective of the Key Area, Consistent, Quality Care, is to ensure that all children, young people and their families, carers and support systems experience mental health care and treatment for common mental health disorders that is appropriate (evidence-based), inclusive and makes a difference at every encounter with Melbourne Children's Campus staff and clinicians.
In order to achieve this, staff must have the knowledge, tools, and systems to best work together with children, young people and their families/carers and support systems.
To enable the key area objective, the Consistent, Quality Care project team, in consultation with lived experience representatives and senior clinicians and subject matter experts, will develop a suite of clinical resources on common mental health disorders for staff use across the Campus. This suite of resources will include:
- Evidence-based clinical practice guidelines on common childhood mental health disorders
- Associated needs based care and referral pathways including sub-sections for groups with increased vulnerabilities
- Measurement-based care framework embedded into usual care
The first guideline, care pathway and measurement-based care topic the team will be working on is Anxiety disorders.
Meet our Lived Experience Advisors for Consistent, Quality Care
The vital contributions of people of lived and living experience of mental ill health and recovery will help us to ensure our practice change and improvement projects in Consistent, Quality Care (CQC) are authentic, child and family centred and consider the diversity of experience, circumstances and needs of infants, children and young people and their parents, carers and supporters who seek care and services from the Melbourne Children’s Campus. In July, we were lucky enough to welcome six Lived Experience Advisors (LEAs) to our CQC team. This group are very much now a part of our team and have already made incredible contributions to our work in progress. We recently asked this group why they had applied for a LEA opportunity with the Campus Mental Health Strategy and below are some of their responses. Nothing about us without us!
“Through storytelling, experience sharing and uninhibited conversation I aim to ensure that the aspirations and needs of people like me—parents/carers of children/young people experiencing a mental health condition—and their families remain central to decision-making and are utilised wherever possible to produce better health outcomes for children and their families.” LC
“As a parent and family carer for four young people with mental health diagnosis, disability, neurodiversity and chronic medical conditions, I was attracted to work with the CGQ team on this project to bring a non-clinical perspective to this project. I plan to share my expertise around what it's like to live these challenges, in all their gritty glory! I hope to be the person who asks the questions an average parent would ask and help the team keep children, young people and their families in the driving seat of these changes.” KR
Evidence Based Clinical Practice Guidelines (CPGs)
Clinical practice guidelines are evidence-based statements that include recommendations intended to optimise patient care and assist health care practitioners to make decisions about appropriate health care for specific clinical circumstances. Clinical practice guidelines should assist clinicians and patients in shared decision making. (Institute of Medicine; 2011)Project Contact Discover more about this project here
Care Pathways (CPs)
Care pathways are evidence-based, mutual, decision-making plans, identifying a sequence of clinical interventions, timeframes, milestones and expected outcomes for children and young people depending on the particular health circumstances. (Queensland Health Clinical Pathways Board definition; 2002)
They support the implementation of evidence-based practice so in other words, they are the operationalisation of clinical practice guidelines.Project Contact Discover more about this project here
Measurement Based Care
Somatising Disorders Project
Many children and young people attend The Royal Children’s Hospital with severe and debilitating physical symptoms. In up to 30% of these instances, the tests for signs of a physical illness return with normal results and with no medical cause found. These cases are regarded as ‘Medically Unexplained Symptoms’. Although this is quite common, Medically Unexplained Symptoms can be confusing and frustrating for children, young people, and their families and/or carers.
In children and young people, a common cause for these perplexing symptoms is a process called ‘Somatising’. This is where a person’s physical symptoms are believed to be caused by underlying stress or psychological problems, such as anxiety. This can result in disruptions of daily life, such as long absences from school, withdrawal, and problems with family and friends.
Research shows that people who Somatise tend to be less aware of psychological or social factors that could be contributing to their physical symptoms. They also tend to seek medical care for their symptoms, rather than psychological support. As such, physical symptoms related to Somatising are more frequently seen in medical settings rather than psychological settings. It is important to note that Somatising can also occur in people with diagnosed medical conditions, especially if they are excessively thinking and feeling about, or acting on their symptoms in ways that result in major distress and disruption to their daily life.
A Somatising diagnosis can be difficult for a young person and their family to accept, given the perceptions and social stigma surrounding psychological and social factors when the young person’s experience is physical in nature. It is also not uncommon for Somatising to affect young people who advise that they normally “don’t feel stressed,” and instead present with physical symptoms of that stress.
Children and young people with Medically Unexplained Symptoms where the cause is thought to be Somatising present with physical symptoms that can affect all body systems. Symptoms include, but are not limited to:
- Breathing difficulties
- Abdominal pain, bloating, nausea, or vomiting
- Heart palpitations
- Headaches, dizziness, non-epileptic seizures, visual disturbances, sensory loss
- Urinary difficulties
At The RCH, children and young people with Medically Unexplained Symptoms that may be due to Somatising are currently managed by general and speciality medical teams. Medical staff exclude medical causes for the physical symptoms with appropriate examination and investigations. Mental health referrals are usually made after a diagnosis of Medically Unexplained Symptoms or Somatising is made. This can leave the child and their family feeling as though others believe that the symptoms must be made up, or that it’s ‘all in their head’. Understandably, this can be frustrating and disheartening, because the symptoms are very real and affecting their life.
Somatising when it presents as Medically Unexplained Symptoms can be complex to manage, particularly when there are further requests for testing and inappropriate interventions. Doing this is risky because the child may be exposed to harm in the process. Accordingly, it is important that Medically Unexplained Symptoms are detected early so these risks are minimised and children and young people receive access to treatments that can assist with symptom management and recovery.
Presently, there is no consistent model of care at The RCH for these children and young people. This has been challenging to develop and implement, because of several factors. Firstly, language and ways of understanding Medically Unexplained Symptoms differs across specialities. Other terms that are used to describe Medically Unexplained Symptoms include functional somatic symptoms, persistent physical symptoms, psychogenic, or psychosomatic, just to name a few. Other terms that are often regarded as falling under the umbrella of Medically Unexplained Symptoms include specific diagnoses, such as Somatic Symptom Disorder and Functional Neurological Disorder (also known as Conversion Disorder). Other conditions such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome are controversial as to whether these should be viewed as Medically Unexplained Symptoms or medical diagnoses. In addition to confusion about terminology, there may also be perceptions that mental health involvement may not be beneficial, as well as a lingering anxiety that a medical condition could still be diagnosed.
Considering these factors, the Somatising Disorders project aims to:
- Develop a common language for Somatising Disorders within the RCH.
- Develop consistent pathways of care for Somatising Disorders, including psychological assessment guidelines.
- Develop resources for families and RCH staff to enhance awareness of Somatising disorders.
- Develop training materials to equip the RCH workforce to talk to parents and carers about somatising disorders and need for mental health care.
The Somatising Disorders research team consists of Dr. Andrew Court, Jenny Cations, and Kristen Van Bael.
This project involves input from key stakeholders within the RCH, and will involve people with lived experience (i.e., children, young people, families and carers) to review language, guidelines, and care pathways for Somatising disorders.
MCRI contact is email@example.comProject Contact Discover more about this project here
Acknowledgement of Country
At Mental Health Central we acknowledge the traditional custodians of the land on which we live, gather and work. We recognise their continuing connection to land, water and community. We pay respect to Elders past, present and emerging.
Proudly supported by the Royal Children’s Hospital Foundation