REIMAGINING POLICY AND MODELS OF SERVICE DELIVERY TO ENHANCE ACCESS AND ENGAGEMENT IN PUBLICLY FUNDED PEDIATRIC REHABILTATION SERVICES

Abstract

Family-centred pediatric rehabilitation services have widely accepted benefits related to a child’s functioning and participation. However, some families experience barriers to accessing and engaging with these services. Families have identified that organizational policies and models of service delivery can impact their experiences with pediatric rehabilitation services. There is a paucity of research focusing on how policies and service delivery models impact access and engagement in Ontario’s publicly-funded pediatric rehabilitation services. Furthermore, there is a gap in the evidence related to recommendations for potential modifications to these structures to enhance access and engagement in these services. The first objective of this thesis is to critically examine policy in publicly-funded pediatric rehabilitation services to understand its impact on access to services. The second objective is to use co-design methodology to improve models of service delivery, with a focus on telerehabilitation, to improve access and engagement in pediatric rehabilitation services. These objectives are achieved through the research outputs of this thesis including recommendations supporting the development of inclusive discharge policies (Chapter 2) and co-created solutions aimed at enhancing experiences with pediatric telerehabilitation (Chapters 3 and 4). Findings from the critical discourse analysis of discharge policies in Chapter 2 emphasized the importance of taking an ethical and family-centred approach to policy development that authentically includes and amplifies family voices. Chapters 3 and 4 used co-design methodology engaging caregivers, clinicians and pediatric rehabilitation service managers to develop solutions focused on improving the 3C’s of communication, consistency and connection to enhance access and engagement with pediatric telerehabilitation services. The findings of this thesis call policy-makers and pediatric rehabilitation service organizations to extend the provision of family-centred service beyond the point of care to include authentic engagement of families in the development of policies and service delivery models.