PACK Child sample materials 2018/09/25 1

PACK Child Practical Approach to Care Kit

Sample of materials

PACK Child sample materials 2018/09/25 2

PACK Child sample materials 2018/09/25 3

The PACK Child guide ................................................................................................... 4

The need for PACK Child .............................................................................................. 4

An overview of the guide ............................................................................................. 5

Development of PACK Child guide ............................................................................... 5

PACK Child content ...................................................................................................... 6

Unique guide features ................................................................................................. 6

Useful tools ................................................................................................................. 7

Illustrated guidance and charts ................................................................................... 7

Integrated features ................................................................................................. 8

PACK Child training ...................................................................................................... 9

An overview of the training ......................................................................................... 9

PACK Child training model ......................................................................................... 10

Overview of PACK Child training materials ................................................................ 11

PACK Child guide............................................................................................................................. 11

PACK Child Board game and answer sheet .................................................................................... 12

Waiting room scene ....................................................................................................................... 13

Case scenarios ................................................................................................................................ 14

Case template ................................................................................................................................. 15

Facility Trainers’ Manual ................................................................................................................ 16

Health systems strengthening .................................................................................... 17

PACK suite of tools .................................................................................................... 18

Monitoring and Evaluation......................................................................................... 19

Contents

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The need for PACK Child

In South Africa, childhood death and disease from infection are declining as a result of the Integrated Management of Childhood Illnesses (IMCI) and the introduction of new vaccines. More children are growing up with long-term health conditions like allergy and HIV. Primary care health workers are required to comply with too many circulars, protocols, policies and guidelines in their everyday practice, but there are few resources that support the health worker to care for children over 5 years or with a long-term health conditions, or that integrate preventative and curative services to provide well child care. For example, asthma, the commonest chronic disease of childhood, affecting 13% of children and accounting for a large proportion of unscheduled primary care visits in South Africa, is poorly managed, and deaths from asthma are among the highest in the world. This, along with requests from users of the Practical Approach to Care Kit (PACK) also known as Adult Primary Care as well as those involved in the delivery of child health in the Western Cape Province, prompted the Knowledge Translation Unit (KTU) of the University of Cape Town Lung Institute to develop a comprehensive, evidence-informed and policy-aligned approach to integrated paediatric primary care - the PACK Child programme.

The PACK Child guide

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An overview of the guide

In The PACK Child guide is a comprehensive, integrated resource that uses familiar design features from adult versions such as easy-to-read algorithms and standardised approaches to routine care, to provide a ‘one-stop’ source of guidance for primary care of the child and young adolescent (0-13 years old). PACK Child hopes to improve the delivery of primary care for children by:

1. Providing an extended scope of content including the needs of children over 5 years old. 2. Actively guiding the clinician to integrate curative and preventive care at every visit. 3. Offering an approach for the well child visit. 4. Allowing for the management of multiple presenting symptoms. 5. Providing an approach for routine care of long-term health conditions. 6. Facilitating task sharing by clarifying roles and responsibilities, referral criteria and prescribing.

Development of PACK Child guide

PACK Child’s development process has been a consultative one which has involved many iterations of each page. Draft pages were subjected to stakeholder review by specialist clinicians, allied health professionals, doctors and nurses working in primary care and school health services, patient advocates and policy makers during clinical working group sessions, and through individual peer review.

Clinical working groups

Nurse Medical officer

Nurse practitioner

Specialist paediatrician

Policy-maker Patient

advocacy group

KTU content

developer

Physio-therapist

Audiologist/ speech

therapist

Family physician

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PACK Child content

PACK child provides an approach to 63 common symptoms and 16 priority long-term health conditions and includes care for the child over 5 years old.

Unique guide features

Integrates routine care into every

visit

Provides standardised approach to 16 priority long-term conditions

Provides a symptom-

based approach to 63 common conditions

One symptom per page

Red box – urgent attention & referral

Algorithms

Symptom based approach

Assess

Advise

Treat

3 tones of grey indicate history, examination & investigations

Standardised approach to long-term health conditions

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Useful tools

Illustrated guidance and charts

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Integrated features

Uses symptoms to

identify chronic

conditions asthma

Looks for co-morbidity

eczema Allergic rhinitis

Allergic conjunctivitis asthma

Supports appropriate

referrals

…refer urgently.

…refer to doctor. … refer to paediatrician.

…refer same day.

Orange text: nurse in accordance with his/her scope of practice (includes the IMCI trained nurse

Nystatin suspension

Blue text: clinical nurse practitioner, doctor Tetracaine 1% gel

Green text: doctor only prescriptions aciclovir

Clarifies roles & responsibilities

& facilitates task sharing

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An overview of the training

The Western Cape Department Health (WC DOH) and KTU have extensive experience implementing the PACK Adult programme. However, the best approach to introducing the broad curriculum of PACK Child in the context of the IMCI programme requires evaluation.

A pilot of the PACK Child programme in the Western Cape has used a phased approach, starting in only one health facility in the 1st phase, expanding to three more health facilities in the 2nd phase and a further six in a 3rd phase. An introductory module was delivered in nine weekly, on-site, case-based training sessions and included a focus on integrating routine care of the child into every visit and the ‘First 1000 Days’ initiative. The training also showcases the alignment of PACK Child content to the IMCI and the holistic approach to not only the child but to the carer too, with prompts to deliver adult care using PACK Adult.

A thorough process evaluation of the pilot phase of PACK child training was deemed necessary for a number of reasons: in order to document its articulation with IMCI; the ability of an ‘adult-inspired’ programme to cater for child health needs; and to describe clinicians’ experiences of paediatric primary care training. A mixed-methods process evaluation provides the opportunity to address these concerns with stakeholders and collaboratively refine the programme. The pilot is scheduled for completion end of August 2018. The pilot will inform further refinements of the PACK Child programme as well as a planned PACK Child trial.

PACK Child training

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Current PACK Child Implementation and Training Plan

PACK Child training model

Equip PACK Child Facility Trainers to comprehensively

manage and co-ordinate PACK Child onsite sessions at

facilities

KTU

tr

aine

r Equip

Faci

lity

staf

f Apply Actively engage in PACK Child onsite learning activities Apply PACK Child guide in practice

KTU

Facility Trainers

Facility staff

Attend a 5 day workshop. 1 PACK Child Facility Trainer per facility (doctor, Child health professional nurse) Know how to use the PACK Child materials. Plan and manage an onsite training roster. Monitor individual and group learning activities.

PACK

Fac

ility

Tr

aine

rs

Train, apply and manage

Overview of nine onsite training

sessions

MODULE 1

Introductory activity Introduce routine care (practice integrating routine care and a symptom) Practice integrating routine care & symptom Growth activity Introduction to the young infant ≤ 2 months (documentation of clinical records) Health system strengthening session Diagnosing long term health conditions TB HIV

Cascade Model

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Overview of PACK Child training materials

PACK Child guide

Description Purpose When it is used Used by whom

A comprehensive, evidence-informed, clinical decision support tool for child primary care that is localised to local policies and protocols.

To support health workers to deliver comprehensive, integrated, policy aligned care in each consultation.

In all PACK training sessions.

• Health workers • PACK Child

Facility Trainers

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PACK Child Board game and answer sheet

Description Purpose When it is used Used by whom

A board game for 2-6 players where players take turns to look in the PACK Child guide for answers to questions posed on the board.

To introduce the scope and value of PACK in an interactive, fun way, it prompts participants to explore the features and clinical content of the guide, (particularly priority conditions) as well as health systems issues.

• Training sessions • Stakeholder

meetings

• PACK Child Facility Trainers

• Presenters of the PACK Child programme

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Waiting room scene

Description Purpose When it is used Used by whom

An illustration of a waiting room of patients with each depicting a clinical case scenario. The scene is familiar to participants with respect to its busyness and demography.

This serves as the curriculum for the training. Participants relate to the people in it as local patients with a real-life story to tell. It also prompts discussion of their own waiting room experiences as health workers.

To introduce the clinical component of the training and to introduce each case scenario.

PACK Child Facility Trainers

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Case scenarios

Description Purpose When it is used Used by whom

These are clinical scenarios or stories linked to the people in the waiting room scene.

To guide participants to navigate specific content and features of the PACK Child guide.

The case scenarios are used in all onsite training sessions.

PACK Child Facility Trainers

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Case template

Description Purpose When it is used Used by whom

This is a standardised format for the delivery of each case scenario. It supports the trainer to provide clinical details of the case only when prompted to do so by participants’ use of the PACK Child guide.

Serves as a script to train a case scenario so that the primary focus is the use and features of the PACK Child guide rather than the clinical detail of the case.

The case template is used to structure all case scenario training sessions and can serve as a script for discussions about health workers’ own patients.

PACK Child Facility Trainers.

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Facility Trainers’ Manual

Description Purpose When it is used Used by whom

This describes the PACK training methodology, onsite session structure and programme administrative processes.

To provide step-by-step instructions for being a PACK Facility Trainer.

Given out during the Facility Trainers’ Workshop, to be used to facilitate onsite training sessions.

PACK Child Facility Trainers

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The PACK Child guide is designed to integrate and reflect existing local policy for primary care delivery while being a comprehensive approach to the individual child patient. The training strategy involves many of the role-players in primary care delivery and targets the primary care facility team as a unit. This inclusive approach offers the opportunity to engage with the several health system realities, such as the reorganisation of the way care is delivered in a primary care facility. This restructure may help to not only streamline the patient journey through the facility but may assist to facilitate task-sharing care between cadres of staff, clarify scope of practice and prescriber levels, and address medication and resource availability e.g. Weight scales, length mats. Below is an example of a PACK Child page “screen the child in the prep room” which can be used to improve the clinic flow such as triaging of sick children in the waiting room at a clinic.

Health systems strengthening

PACK guide development,

revision and training

Streamlining referral

pathways

Clarifying scope

of practice

Expanding prescriber

policy

Evidence informed policy

updates

Rationalising use of

resources

Resolving policy

inconsistencies

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PACK suite of tools

The PACK Child programme will be a valuable addition to the suite of PACK tools that may be used side-by-side in clinics and community settings, articulating with PACK Adult, and, in advanced stages of development, PACK Adolescent, PACK Community (for community health workers) and PACK Information (for patients). This PACK suite of tools aims to provide a continuum of care throughout the lifespan and support important concepts like the maternal-child dyad and the First 1000 days initiative.

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Monitoring and evaluation of the PACK Child programme can occur at several levels - the individual clinician, facility, regional and system-wide - to ensure that the programme is being implemented effectively. Regular PACK Child training reports will be provided to programme managers.

M&E material Visual demonstration

PACK Child onsite training register

Implementation record

Monitoring and Evaluation

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© 2017, University of Cape Town Lung Institute (Pty) Ltd - all rights of copyright vesting in all the original works and material used by the University of Cape Town Lung Institute (Pty) Ltd in the preparation and development of the PACK Primary Care Guide for the Child 2017/18 (Pilot version, Western Cape Edition), in and during 2017/18.