Models, theoretical design and formal evaluation of integrated specialist community health service provision for the first 2000 days: a scoping review.

OBJECTIVE: This scoping review identifies evidence for design, models and evaluation of integrated care service provision for families and children in the first 2000 days, in the context of community-based specialised health, education and welfare services. DESIGN: Scoping review following the Joanna Briggs scoping review method. DATA SOURCES: Medline, CINAHL, Cochrane and PsycINFO. Grey literature used a manual search of original articles, and snowball technique to identify government and policy documents relevant to Australia. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Inclusion criteria were 'population' of prebirth to age 5; 'concept' of design, models and delivery of integrated specialist care for children and families; and 'context' of community-based specialised health, education and welfare services. Medical Subject Heading (MeSH) and free text searches were conducted in electronic database sources. Limits January 2010 to October 2022, full text, English language, human. DATA EXTRACTION AND SYNTHESIS: Data were extracted independently by two authors using a piloted data extraction table and presented in table and narrative form. RESULTS: Full text of 11 articles were reviewed, domains were coded using four domains of a framework identified in one reviewed article to maintain consistency of reporting; 'governance,' 'leadership,' 'organisational culture and ethos,' and 'front-line interdisciplinary practice.' A fifth domain was identified, 'access.' CONCLUSIONS: Services providing integrated care for families in the early years will ideally be based on values generated through codesign with families and the community. Considerations include sound governance and leadership, shared vision, and commitment to providing accessible and culturally safe family-centred care.

Applying an authentic partnership approach to facilitate optimal health of Aboriginal children.

The aim of this development paper is to inform the ongoing implementation of the partnership approach with Aboriginal families in Australia. As almost all Community Health Nurses employed by the Health Department of Western Australia, Country Health Service are non-Aboriginal, there are a number of factors that may, potentially, limit their capacity to work effectively with the primary caregivers of Aboriginal children.Historically, much that has been written about the health and development of Aboriginal people in Australia has been negative and derogatory with wide criticism for their non-participation with health services and healthy lifestyle activities. Not only has this "deficit discourse" approach proved to be unhelpful in terms of improving the health and well-being of Aboriginal people but also there is mounting evidence that it has been detrimental to mental and physical health and capacity to achieve autonomy in all aspects of life.In response to the voices of Aboriginal people, the partnership approach to care has been promoted for use by Community Health Nurses in Western Australia. However, the implementation of the approach is not always genuinely strength based, and it does not always focus on mutual goal setting within authentic partnership relationships. The partnership approach has the potential to improve the lives of Aboriginal people if it is implemented with appropriate cultural sensitivity, shared responsibility, dignity and respect.

Identification of models, theoretical design and formal evaluation of integrated specialist community health service provision for the first 2000 days: a protocol for a scoping review.

INTRODUCTION: The first 2000 days of a child's life (during pregnancy up to age 5 years) represent a critical period, in which early interventions reduce risk associated with developmental delay, disability and intergenerational disadvantage. The risk is exacerbated by barriers to specialised early intervention for children and families. This scoping review seeks to contribute to the evidence for sustaining integrated community-based specialist care in these earliest years of a child's life. METHODS AND ANALYSIS: The Joanna Briggs Institute scoping review framework will be followed. Inclusion and exclusion criteria for screening of literature is predefined, guided by the criteria of population, concept and context. The review will identify models of care delivery, and will identify quality of care outcomes that have been measured, including evidence of reliability and validity. Sources of evidence will include CINAHL, Cochrane databases, Medline, PsycINFO and Scopus. ETHICS AND DISSEMINATION: In a three-part study, evidence synthesis from the scoping review of the literature; mapping of existing specialist early years services in one community and a consumer consultation (Curtin University Human Research Ethics approval HRE2021-0546) in the same community will inform a model of integrated care that accounts for the context of the community it seeks to serve. Results will be disseminated by peer-reviewed publications and conference presentations, contributing to the evidence base for delivering sustainable community-based integrated care in the context of the first 2000 days. This protocol is specific to the scoping review.

Pediatric and child health nursing: A three-phase research priority setting study in Western Australia.

PURPOSE: Priority settings are important to plan and direct future research. The aim of this study was to identify the top ten pediatric and child health nursing research priorities from the perspectives of consumers, community, and healthcare professionals in Western Australia. DESIGN AND METHODS: This study used an adapted James Lind Alliance Priority Setting Partnership design with three phases. 1) A planning workshop to inform a survey. 2) A survey using five open-ended-questions distributed between October 2020 and January 2021 through social media and healthcare professionals' emails. Responders' statements were analyzed with content analysis. 3) A consensus workshop to finalize and rank the themes. RESULTS: The planning workshop participants (n = 25) identified gaps such as community child healthcare and confirmed lack of consumer engagement in previous studies. The survey responses (n = 232) generated 911 statements analyzed into 19 themes. The consensus workshop participants (n = 19) merged and added themes, resulting in 16 final themes. The top three ranked themes were: 'access to service', 'mental health and psychological wellbeing', and 'communication'. CONCLUSIONS: The research themes are necessarily broad to capture the wide range of issues raised, reflecting the scope of pediatric and child health nursing. PRACTICE IMPLICATIONS: The priorities will inform future research to be directed to areas of priority for stakeholders who have often not had a say in setting the research agenda.

Patient experience surveys for children's community health services: A scoping review.

Patient experience surveys have a user focus and measure the quality of person-centered health care for hospital inpatients and consumers of community health services, providing a governance process to evaluate the quality of care and to action improvement. Experience of care has been described as effective communication, respect and dignity, and emotional support. Measurement criteria for these domains are not standardized, leading to inconsistent reporting of patient experience. The objective of this scoping review was to synthesize evidence for measuring experience of care in children's community health services using the Joanna Briggs Institute framework for scoping review method. Three parent-reported surveys met the inclusion criteria, and 50 survey items were assessed by expert reviewers for fit to domains of healthcare experience. Conceptual domains of parent experience in children's community health services included respect and dignity, effective communication, and emotional support. A gap was identified, in that few items in identified surveys measured emotional support. This contribution will promote consistent reporting of healthcare experience, informing policy and practice for person-centered health care.

Community midwifery: a primary health care approach to care during pregnancy for Aboriginal and Torres Strait Islander women.

Comprehensive primary health care is integral to meaningful client-centred care, with nurses and midwives central to partnership approaches with individuals, families and communities. A primary health model of antenatal care is needed for Aboriginal and Torres Strait Islander women in rural and remote areas, where complex social determinants of health impact on pregnancy outcomes, early years and lifelong health. Staff experiences from a community midwifery-led antenatal program in a remote Western Australian setting were explored, with the aim of investigating program impacts from health service providers' perspectives. Interviews with 19 providers, including community midwives, child health nurses, program managers, a liaison officer, doctors and community agency staff, examined elements comprising a culturally safe community antenatal program for Aboriginal and Torres Strait Islander women, exploring program benefits and challenges. Thematic analysis derived five themes: Organisational and Accessibility Factors; Culturally Appropriate Support; Staff Availability and Competencies; Collaboration; and Sustainability. The ability of program staff to work in culturally safe partnerships with clients in collaboration with community agencies was essential to building meaningful and sustainable antenatal strategies. Midwifery primary health care competencies were viewed as a strong enabling factor, with potential to reduce health disparities in accordance with Australian Government and research recommendations.

The Relevance of Aboriginal Peer-Led Parent Support: Strengthening the Child Environment in Remote Areas.

This participatory action research study was situated within a larger research study, which investigated the development of a peer-led Aboriginal parent support program in the remote setting of Halls Creek in Western Australia. The aim of this smaller research component was to explore the self-perceived role of home visiting peer support workers in this remote area. Participatory Action Research methodology was employed, within which eleven Action Learning Sets were used to facilitate participant collaboration (n = 8). All participant data was collected in focus groups during the Action Learning Sets where culturally appropriate home visiting parent support strategies were developed and examined in partnership with a child health nurse researcher. Data were analyzed using thematic analysis with three themes relating to the peer support workers' self-perceived role being identified: Helping parents be strong for their children; Strengthening culture; and Facilitating effective communication. These elements support peer support worker activities, helping parents to enhance their children's physical and psychosocial developmental environment. This research highlights the critical emerging role of peer support workers in home visiting family support in a remote area of Australia.

Aboriginal parent support: A partnership approach.

AIMS AND OBJECTIVES: This study was positioned within a larger action research study relating to a peer-led Aboriginal home visiting parent support program in an urban Western Australian setting. The aims for this study component were to identify program elements, exploring participants' perceptions of the program's suitability, feasibility, acceptability and effectiveness to inform program model recommendations and add to the body of knowledge on effective Aboriginal peer-led program models. BACKGROUND: The ability of Aboriginal parents to develop positive family environments is crucial, with parent support needing to be reflexive to local needs and sociocultural influences. Culturally appropriate service provision needs meaningful and acceptable strategies. DESIGN: This study was situated within a critical paradigm supporting Participatory Action Research methodology, using Action Learning Sets as the participant engagement and data collection setting. METHODS: Within ten Action Learning Sets, focus group interviews were carried out with Aboriginal peer support workers, a non-Aboriginal parent support worker, an Aboriginal program coordinator, an Aboriginal education support officer and non-Aboriginal program managers (n = 8), and individual interviews with parents (n = 2) and community agencies (n = 4). Data were analysed using thematic analysis. RESULTS: Five themes were derived from peer support worker and community agency cohorts: peer support worker home visiting skills; responding to impacts of social determinants of health; client support and engagement; interagency collaboration; and issues addressing program sustainability. Parent responses augmented these themes. CONCLUSIONS: Participants identified five key elements relating to peer-led home visiting support for Aboriginal parents. These are uniquely placed to inform ongoing program development as there is little additional evidence in wider national and international contexts. RELEVANCE TO CLINICAL PRACTICE: Engagement with communities and peer support workers to develop culturally relevant partnerships with Aboriginal families is integral to contemporary child health practice. Ongoing nurse support is needed for peer support worker role development. Indigenous Australian peoples are people who identify as Aboriginal or Torres Strait Islander. Respectfully, throughout this paper, they will be described as Aboriginal.

Peer-led Aboriginal parent support: Program development for vulnerable populations with participatory action research.

BACKGROUND: Participatory action research (PAR) is a credible, culturally appropriate methodology that can be used to effect collaborative change within vulnerable populations. AIM/OBJECTIVE: This PAR study was undertaken in a Western Australian metropolitan setting to develop and evaluate the suitability, feasibility and effectiveness of an Aboriginal peer-led home visiting programme. A secondary aim, addressed in this paper, was to explore and describe research methodology used for the study and provide recommendations for its implementation in other similar situations. METHODS: PAR using action learning sets was employed to develop the parent support programme and data addressing the secondary, methodological aim were collected through focus groups using semi-structured and unstructured interview schedules. Findings were addressed throughout the action research process to enhance the research process. RESULTS: The themes that emerged from the data and addressed the methodological aim were the need for safe communication processes; supportive engagement processes and supportive organisational processes. CONCLUSIONS: Aboriginal peer support workers (PSWs) and community support agencies identified three important elements central to their capacity to engage and work within the PAR methodology. This research has provided innovative data, highlighting processes and recommendations for child health nurses to engage with the PSWs, parents and community agencies to explore culturally acceptable elements for an empowering methodology for peer-led home visiting support. There is potential for this nursing research to credibly inform policy development for Aboriginal child and family health service delivery, in addition to other vulnerable population groups. Child health nurses/researchers can use these new understandings to work in partnership with Aboriginal communities and families to develop empowering and culturally acceptable strategies for developing Aboriginal parent support for the early years. Impact Statement Child health nurses and Aboriginal communities can collaborate through participatory action research to develop peer-led support for the early years. Indigenous Australian peoples are people who identify as Aboriginal or Torres Strait Islander. Respectfully, throughout this paper, they will be described as Aboriginal.

Effectiveness and experiences of families and support workers participating in peer-led parenting support programs delivered as home visiting programs: a comprehensive systematic review.

BACKGROUND: Designing child and family health services to meet the diverse needs of contemporary families is intended to minimize impacts of early disadvantage and subsequent lifelong health and social issues. Innovative programs to engage families with child and family support services have led to interest in the potential value of peer-led home visiting from parents in local communities. There is a range of benefits and challenges identified in a limited number of studies associated with home visiting peer support. OBJECTIVES: The objective of the review is to identify: INCLUSION CRITERIA PARTICIPANTS: Families/parents with one or more children aged zero to four years, peer support workers and their supervisors. INTERVENTION AND PHENOMENON OF INTEREST: Peer-led home visiting parenting support programs that use volunteer or paraprofessional home visitors from the local community compared to standard community maternal-child care. The phenomenon of interest will be the relationships between participants in the program. TYPES OF STUDIES: Quantitative studies: randomized control trials (RCTs). Qualitative studies: grounded theory and qualitative descriptive studies. OUTCOMES: Parental attitudes and beliefs, coping skills and confidence in parenting, parental stress, compliance with child health checks/links with primary healthcare services, satisfaction with peer support and services and the nature of the relationship between parents and home visitors. SEARCH STRATEGY: The search strategy will include both published and unpublished studies. Seven journal databases and five other sources will be searched. Only studies published in the English language from 2000 to 2015 will be considered. METHODOLOGICAL QUALITY: Studies were assessed by two independent reviewers using standardized critical appraisal tools from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) as appropriate. DATA EXTRACTION: Both quantitative and qualitative data were independently extracted by two reviewers using standardized data extraction tools from the JBI-MAStARI and the JBI-QARI, respectively, including qualitative and quantitative details about setting of interventions, phenomena of interest, participants, study methods and outcomes or findings. DATA SYNTHESIS: For quantitative findings, statistical pooling was not possible due to differences in interventions and outcome measures. Findings were presented in narrative form. Qualitative findings were aggregated into categories based on similarity of meaning from which synthesized findings were generated. RESULTS: Quantitative results from two RCTs demonstrated positive impacts of peer-led home visiting parent support programs including more positive parenting attitudes and beliefs, and more child preventative health care visits.Fifteen qualitative findings from two studies were aggregated into five categories from which two synthesized findings emerged. Parents and home visitors identified similar components as contributing to their program's success, these being quality of relationships between parents and home visitors with elements being mutual respect, trust and being valued within the partnership. In addition, home visitors identified importance of enabling strategies to develop relationships. They also needed supportive working environments with clinical staff and management. CONCLUSION: The current review indicates a positive impact of peer-led home visiting parent support programs, incorporating a framework of partnership between parents and home visitors, on mother-infant dyads. Positive changes in parenting attitudes and beliefs, and increased number of child preventative healthcare visits are supported by the quality of the relationship between parent and home visitor, and home visitors' working environments. IMPLICATIONS FOR PRACTICE: The essential characteristics of an effective parent support program are strategies for relationship building between parents and home visitors; ongoing staff and home visitor education to enhance communication, collaboration and working in partnership; supervision by team leaders; and continuous quality improvement. IMPLICATIONS FOR RESEARCH: The focus of further research should be on confirmatory studies using an action research methodology and the cost-effectiveness of these models.

Perinatal depression and screening among Aboriginal Australians in the Kimberley.

PROBLEM: Adhoc culturally questionable perinatal mental-health screening among Aboriginal women in the Kimberley. BACKGROUND: Mental-health issues, substance abuse and suicide attempts are high among young Aboriginal women in Australia. There is no evidence that the Edinburgh Postnatal Depression Scale (EPDS) is effective or culturally safe. Screening practices are complicated by limited understanding of the complex cultural interface between Western and Aboriginal beliefs and notions about health and mental-health. QUESTION: What is the current context of perinatal mental-health screening practices among Aboriginal women in the Kimberley and what might be considered a culturally safe approach? METHODS: A review of the literature and exploration of current screening practices preceded community participatory action research (CPAR) of perinatal mental-health screening. RESULTS: More than 100 Kimberley women and 72 health practitioners contributed to this joint strategic body of work. Recommendations for practice include one single culturally appropriate Kimberley version of the EPDS.

The emerging role of the urban-based aboriginal peer support worker:A Western Australian study.

Purpose: To explore the self-perceived role of the Aboriginal peer support worker working with familieswith young children. This study was a component of a larger participatory action research study under-taken in a Western Australian metropolitan setting to develop and evaluate the suitability, feasibility andeffectiveness of an Aboriginal peer-led home visiting program. Methods: Focus group interviews were carried out with peer support workers using unstructured andsemi-structured interviews within Action Learning Sets. Data were analysed using thematic analysis.Results: The overarching theme on the self-perceived role of the Aboriginal peer support worker wasGiving Parent Support, with subsidiary themes relating to development and ongoing sustainability of thesupport. Discussion: The peer support workers viewed their role as providing parent support through enablingstrategies which developed client acceptance and trust, delivered culturally relevant support, advocatedfor families, developed therapeutic engagement and communication strategies, and created safe homevisiting practices. They recognised the importance of linking families with community support such ascommunity child health nurses which was important for improving long term physical and psychosocialhealth outcomes for children. Conclusion: Aboriginal Peer Support Workers identified their emerging integral role in the developmentof this unique culturally acceptable home visitingsupport for Aboriginal parents. Innovative approachestowards client engagement demonstrated their value in developing creative ways of working in part-nership with families, community support services and child health nurses across a range of challengingpsychosocial environments.

The WA Goldfields Aboriginal Community Antenatal Program­A community midwifery initiative.

Aim: To investigate the acceptability and satisfaction with the Aboriginal Community Antenatal Programby staff in the program and partner agencies. Design: A Strengths, Weaknesses, Opportunities and Threats framework guided the research and datacollection methods. Mixed methodology was used, accessing qualitative and quantitative informationfrom data bases, program and supporting agency staff. Quantitative data were analysed through a socialsciences statistical package. Qualitative data were identified through questionnaires and analysed usingthematic analysis. Setting: Remote Aboriginal communities in the Goldfields region of Western Australia.Participant sources: Twenty two participants including program and supporting agency staff.Main outcome measures: This study measures acceptability and satisfaction of program antenatal andpre-conception activities by program staff and partner agencies. Results: Qualitative results indicate acceptability and satisfaction with the program, identifying a rangeof organisational, staffing, cultural and interagency issues relating to a model of service provision. Quan-titative data suggested positive program outputs from service delivery. Conclusion: Findings suggest the Aboriginal Community Antenatal Program and partner agencies areincreasing provision of community based pre-conception and antenatal health services and enhancingcollaboration between a range of health provider agencies, with partnerships between Aboriginal andnon-Aboriginal program staff contributing to an emerging model of community antenatal care.

The Halls Creek Community Families Program: Elements of the role of the child health nurse in development of a remote Aboriginal home visiting peer support program for families in the early years.

OBJECTIVE: To undertake an evaluation of elements of the role of the child health nurse in the development of peer support for Aboriginal families with young children in a remote setting. DESIGN: The Halls Creek Community Families Program uses expertise of peer support workers to support parents of young families. In stage one, participatory action research was used. The program facilitator, who was a child health nurse, undertook action learning sets where issues were explored relating to home visiting strategies to families. Additionally, the facilitator maintained a reflective practice diary. Outcomes contributed to stage two, where an independent researcher evaluated program changes.This report relates to stage one, which used descriptive qualitative data from interviews with peer support workers and community support agencies, and the facilitator's reflective diary. Data were analysed by thematic analysis, focusing on elements of the role of the facilitator in program development. SETTING: A remote Aboriginal community in the Kimberley region of Western Australia. PARTICIPANTS: Eight peer support workers and five health and welfare professionals from community support agencies. MAIN OUTCOME MEASURES: This study measures changes in participants' understanding of the role and scope of practice of the child health nurse facilitator, thereby supporting improved support for Aboriginal families with young children. RESULTS: Thematic analysis identified three major changes in understanding the child health nurse facilitator role: working in partnership, communication strategies and education and organisational strategies. CONCLUSION: Findings suggest empowering benefits for Aboriginal peer support workers from the facilitating role of the child health nurse.

Rainbows: a primary health care initiative for primary schools.

Within the current Australian health system is the understanding of a need to change from the predominate biomedical model to incorporate a comprehensive primary health care centred approach, embracing the social contexts of health and wellbeing. Recent research investigated the benefits of the primary health care philosophy and strategies in relation to the Rainbows programme which addresses grief and loss in primary school aged students in Western Australia. A multidisciplinary collaboration between the Western Australian Departments of Health and Education enabled community school health nurse coordinators to train teacher facilitators in the implementation of Rainbows, enabling support for students and their parents. The results of this qualitative study indicate that all participants regard Rainbows as effective, with many perceived benefits to students and their families.

Home oxygen therapy for infants and young children with acute bronchiolitis and other lower respiratory tract infections: the HiTHOx program.

BACKGROUND: Acute lower respiratory tract infection (LRTI) including bronchiolitis, is one of the leading causes of pediatric hospital admissions worldwide. Recent studies have demonstrated that some children with acute bronchiolitis can be successfully managed using home oxygen therapy. AIM: To report the impact of a Hospital in The Home Oxygen therapy program (HiTHOx) for selected infants and young children with acute bronchiolitis and other LRTI. FINDINGS: The HiTHOx program appears to be a safe model of care for carefully selected infants and young children with acute bronchiolitis and LRTI that reduces the hospital length of stay. CONCLUSIONS: The HiTHOx program provides an alternative model of care for infants and young children with acute LRTI. Implementation of models of care similar to that of the HiTHOx program in other pediatric health services may have the potential to create additional bed capacity, at the time of year when it is most needed.

Indigenous families' use of a tertiary children's hospital in Australia.

There has been little research into Australian Indigenous families' use of a tertiary paediatric hospital in Western Australia. Scrutiny of existing scientific literature and the reports of government and non-governmental organisations from 1995 onwards did not identify clear referral pathways, health-seeking behaviours or preferences of Indigenous families for a culturally safe hospital model. Family-centred care requires an understanding of how Indigenous children and families arrive at a health service, and the cultural and practical implications of large distances and of leaving other family members behind.

Family-centred care for hospitalised children aged 0-12 Years: A systematic review of quasi-experimental studies.

BACKGROUND: Family-centred care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. It is a widely used model in paediatrics, and is felt instinctively to be the best way to provide care to children in hospital. However, its effectiveness has not been established. OBJECTIVES: The objective of this review was to identify the effectiveness of family-centred models of care for children (excluding premature neonates) when compared to standard models of care. INCLUSION CRITERIA: The review considered quasi-experimental studies of children aged 0-12 years, their families and/or attending health professionals. Interventions for inclusion were family-centred polices, family support, communication, educational and environmental. Outcomes of interest covered three categories: the child, parent and staff. These included psychological, behavioural, physical, developmental, knowledge, satisfaction and attitudinal outcomes. The degree of family-centredness for eligible studies was scored using a modified rating scale based on that developed by Trivette.This review considered studies that included hospitalised children aged 0-12 years (excluding premature neonates), their family and/or health care professionals.The review considered studies that evaluated the effectiveness of family-centred models of care for hospitalised children when compared to standard models of care.The review considered quasi-experimental studies for inclusion to enable the identification of current best evidence regarding the effectiveness of family-centred models of care on child, family and health service outcomes. Quasi-experimental design includes experimental studies in which participants are not randomly assigned to treatment conditions.This review considered studies that included the following outcome measures: SEARCH STRATEGY: The search strategy identified published and unpublished studies dated from 2004 to December 2011. Individual search strategies were developed for six databases and eight resources. METHODOLOGICAL QUALITY: To be considered for inclusion in the review, each study had to meet a pre-established level of family-centredness, as determined using a modified rating scale based on that developed by Trivette.The study that met the required degree of family-centredness and other eligibility criteria was then assessed by two independent reviewers for methodological quality prior to inclusion in the review, using standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. The third reviewer was not required. DATA COLLECTION: Data were independently extracted from this remaining quasi-experimental study by two independent reviewers, using a standardised data extraction tool. Data were extracted including specific details about the interventions, population, study methods and outcomes of significance to the review question and specific objectives. The third reviewer was not required as there were no disagreements between the reviewers. DATA SYNTHESIS: Pooling of quantitative data was not possible as only one study was included in this review. Therefore, the quantitative results of the study have been presented in narrative form. RESULTS: Only one study met the inclusion criteria for this review. The study addressed three interventions (information sharing, joint decision making, and participating in care activities), and two outcomes (self-efficacy in participatory involvement in child care and satisfaction with nursing care). The study found that at Day 5 after Paediatric Intensive Care Unit admission the mothers' self-efficacy in participatory involvement in child care and satisfaction with nursing care in the experimental group were significantly higher than in the control group. CONCLUSIONS: Based on this review alone, and the acknowledgement that only one quasi-experimental study met the inclusion criteria, no firm conclusion could be drawn about the effectiveness of family-centred care for children in hospital. However, taken with the recent Cochrane review update on the effectiveness of the model of family-centred care, we suggest that it is time to search for a more effective model of care delivery which supports the child and family without putting undue pressure on families to stay with their child if it is difficult to do so.