Study protocol for a multi‐centre parallel two‐group randomized controlled trial evaluating the effectiveness and impact of a pain assessment and management program for respite workers supporting children with disabilities

Challenges and recommendations for advancing respite care for families of children and youth with special health care needs: A qualitative exploration

INTRODUCTION

Caring for children and youth with special health care needs (CYSHCN) is a significant undertaking for families. While respite care is intended to address this burden, demand continues to exceed supply. Exploring the perspectives of respite service providers (SPs) and stakeholders (SKs) provides unique insight into families' needs and respite care systems.

METHODS

We conducted semistructured interviews with 41 respite care SPs and SKs across four Canadian provinces to ascertain perspectives on current and ideal respite care for families of CYSHCN. The analysis included delineating units of meaning from the data, clustering units of meaning to form thematic statements and extracting themes. The second-level analysis involved applying themes and subthemes to cross-functional process maps.

FINDINGS

Participants noted the critical, but sometimes absent role of Community Service Workers, who have the ability to support families accessing and navigating respite care systems. SPs and SKs identified current respite systems as operating in crisis mode. New findings suggest an ideal respite care system would incorporate advocacy for families, empower families and value CYSHCN, their families and respite workers.

CONCLUSION

The evidence of unmet respite care needs of families of CYSHCN across Canada has long been available. Our findings identifying respite system challenges and solutions can be used by funders and policymakers for planning and enhancing resources, and by healthcare professionals, respite care providers and SKs to understand barriers and take action to improve respite outcomes to meet the respite needs of all families and CYSHCN.

PATIENT OR PUBLIC CONTRIBUTION

The research team is composed of patients, researchers, clinicians and decision-makers along with our Family Advisory Committee (FAC) composed of members of families of CYSHNC. The FAC was formed and met regularly with research team members, knowledge users and collaborators throughout the study to provide input on design, review themes and ensure findings are translated and disseminated in a meaningful way.

A Randomized Controlled Trial Evaluating a Pain Training for Respite Workers Supporting Children With Disabilities Part Two: Training Evaluations and the Impact of Training on Knowledge Application

Within a parallel-group randomized control trial, pain training's impact on Respite Workers' (RW) care approaches and training evaluations was explored. RW (n = 158) from 14 organizations received pain or control training following randomization. Researchers were blind until randomization; allocations were not shared explicitly with organizations/participants. Participants completed a strategy use questionnaire immediately before and an evaluation immediately after training completion. Four-to-6 weeks later, participants completed the strategy use questionnaire and semistructured focus groups. No differences in pain approaches were noted in strategy use questionnaires. Per focus groups, both groups acquired a "knowing" about pain and applied pain-related care approaches in similarly. Pain training participants identified need for "growing and strengthening" pain knowledge. Training endorsements were favorable. RW pain training has value and may impact practice.

A Randomized Controlled Trial Evaluating a Pain Assessment and Management Program for Respite Workers Supporting Children With Disabilities Part One: Pain-Related Knowledge and Perceptions

This parallel group randomized controlled trial tested effectiveness of the Let's Talk About Pain training on respite workers' (RW) pain-related knowledge and feasibility-confidence-skill ratings using between-group and within-group analyses. Fourteen children's respite organizations were randomized to pain or control training. Participants (nintervention = 66; ncontrol = 92) underwent a 3-3.5 hour training and completed measures at pre-, post-, and 4-6 week follow-up. Intention-to-treat (nintervention = 65; ncontrol = 92) and per-protocol (nintervention = 26-38; ncontrol = 40-57) analyses were conducted. Pain training participants demonstrated significantly higher pain knowledge and feasibility-confidence-skill ratings post-follow-up versus control group and significant increases in knowledge from pre-post. Significant gains were maintained from post-follow-up. Results represent a promising step towards enhancing pain-related care for children with IDD.

The importance of feasible outcome evaluations: Developing stakeholder‐informed outcomes in a randomized controlled trial for children’s respite workers receiving pain training

Objective

Pain is common for children with intellectual and developmental disabilities. It is critical that caregivers have adequate pain assessment and management knowledge. The Let’s Talk About Pain program has shown promise to provide pain‐related knowledge and skills to respite workers; however, more systematic evaluation of the program is needed. This study aims to support Let’s Talk About Pain’s RCT development by using stakeholder input to help determine a feasible approach for collecting behaviorally based outcomes. A secondary aim is to discuss relevant considerations and implications for others in the disability field conducting similar work.

Methods/Design

Four employees in children’s respite organizations completed telephone interviews lasting approximately fifteen minutes and a questionnaire about feasible data collection approaches.

Results

The use of questionnaire and focus group methodology was determined to be the most feasible method to evaluate participants’ pain‐related approaches in practice.

Conclusions

Special consideration should be made when making methodological‐related choices during study development to help ensure study feasibility. The iterative approach described in this paper may also be helpful in clinical settings when designing program evaluations to enhance feasibility and suitability; it is particularly important for multifaceted organizations supporting individuals with complex needs including those with intellectual and developmental disabilities.