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Edwards RC, Kneale D, Stansfield C, Lester S. "They don't have the luxury of time": interviews exploring the determinants of public health research activity that contextualise embedded researcher roles in local government. Health Res Policy Syst 2024; 22:88. [PMID: 39085902 PMCID: PMC11292997 DOI: 10.1186/s12961-024-01162-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 06/07/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Embedded researchers are a novel intervention to improve the translation of research evidence into policy and practice settings, including public health. These roles are being implemented with increasing popularity, but they often lack clear evaluative frameworks. Understanding initial levels of research activity, including associated barriers and opportunities, is essential to developing theories of change and thus shaping the roles and defining expectations. We aimed to identify the principal determinants of research activity in public health that contextualise embedded researcher roles, including attributes of the embedded researcher themselves. METHODS We undertook seventeen semi-structured interviews with embedded researchers in diverse public health settings in English local government. Interviews were analysed using thematic analysis. RESULTS We identified thirteen interlinked determinants of research activity within local government public health settings. Research and interpersonal skills, as well as pre-existing connections and knowledge within local government, were highly valued individual attributes for embedded researchers. Resource deficiencies (funding, time, and infrastructure) were primary barriers to research activity, whereas a strong local appetite for evidence informed decision making presented a valuable opportunity. However, there was inconsistencies across public health teams relating to perceptions of what constituted "research" and the resources that would be required. CONCLUSIONS Our results suggest that successful embedded researchers will have equally strong research and communication skills and should be offered mentorship and clear career progression pathways. Perceptions of research within local government are closely linked to resource deficiencies and senior endorsement. Embedded researchers could benefit from taking the time to develop locally contextualised knowledge of this research culture. Theories of change for embedded researchers should conceptualise the interconnections across individual, interpersonal, and organisational barriers and opportunities underlying local government research activity. Further research is needed to identify methods for exploring the influence of embedded researchers as well as to unpack the stages of research activity within local government and the associated behaviours.
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Affiliation(s)
- Rachael C Edwards
- Evidence for Policy and Practice Information Centre, UCL Social Research Institute, Institute of Education, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
| | - Dylan Kneale
- Evidence for Policy and Practice Information Centre, UCL Social Research Institute, Institute of Education, University College London, Gower Street, London, WC1E 6BT, United Kingdom
| | - Claire Stansfield
- Evidence for Policy and Practice Information Centre, UCL Social Research Institute, Institute of Education, University College London, Gower Street, London, WC1E 6BT, United Kingdom
| | - Sarah Lester
- Evidence for Policy and Practice Information Centre, UCL Social Research Institute, Institute of Education, University College London, Gower Street, London, WC1E 6BT, United Kingdom
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Kneale D, Stansfield C, Goldman R, Lester S, Edwards RC, Thomas J. The implementation of embedded researchers in policy, public services, and commercial settings: a systematic evidence and gap map. Implement Sci Commun 2024; 5:41. [PMID: 38627834 PMCID: PMC11020794 DOI: 10.1186/s43058-024-00570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Embedding researchers into policy and other settings may enhance research capacity within organisations to enable them to become more research active. We aimed to generate an evidence map on evaluations of embedded researcher interventions to (i) identify where systematic reviews and primary research are needed and (ii) develop conceptual understandings of 'embedded researchers'. We define 'embedded researchers' through a set of principles that incorporate elements such as the aim of activities, the types of relationships and learning involved, and the affiliations and identities adopted. METHODS We included studies published across all sectors, searching fourteen databases, other web sources and two journals for evaluations published between 1991 and spring 2021. Data were extracted using a coding tool developed for this study. We identified new typologies of embedded researcher interventions through undertaking Latent Class Analysis. RESULTS The map describes 229 evaluations spanning a variety of contexts. Our set of principles allowed us to move beyond a narrow focus on embedded researchers in name alone, towards consideration of the wide range of roles, activities, identities, and affiliations related to embedded researchers. We identified 108 different allied terms describing an embedded researcher. Embedded researcher activity spanned a continuum across lines of physical, cultural, institutional, and procedural embeddedness (from weaker to more intense forms of embeddedness) and took a range of forms that bridge or blur boundaries between academia and policy/practice. CONCLUSIONS We developed a broad map of international embedded researcher activity in a wide range of sectors. The map suggests that embedded researcher interventions occupy a broader suite of models than previously acknowledged and our findings also offer insight on the type and nature of this literature. Given the clear policy interest in this area, a better understanding of the processes involved with becoming embedded within an organisation is needed. Further work is also necessary to address the challenges of evaluating the work of embedded researchers, including consideration for which outcome measures are most appropriate, to better understand their influence.
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Affiliation(s)
- Dylan Kneale
- EPPI Centre, UCL Social Research Institute, University College London, London, UK.
| | - Claire Stansfield
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | | | - Sarah Lester
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Rachael C Edwards
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - James Thomas
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
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Newington L, Alexander CM, Kirby P, Saggu RK, Wells M. Reflections on contributing to health research: A qualitative interview study with research participants and patient advisors. PLoS One 2022; 17:e0279354. [PMID: 36534681 PMCID: PMC9762575 DOI: 10.1371/journal.pone.0279354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The aims of this study were to explore individuals' experiences of contributing to health research and to identify the types of impact that are perceived as important by participants or patient and public advisors. Specifically, research led by NMAHPP clinicians (Nursing, Midwifery, Allied health professions, Healthcare science, Psychology and Pharmacy). METHODS Semi-structured one-to-one interviews were conducted with health research participants and patient or public advisors. Interviewees were recruited from five UK sites and via social media. Interview transcripts were analysed using Thematic Analysis to identify key themes and areas of disagreement. RESULTS Twenty-one interviews were completed, and four main themes were identified. The first, optimising research experiences, included personal reflections and broader recommendations to improve participant experiences. The second, connecting health research with healthcare, described research as key for the continued development of healthcare, but illustrated that communication between research teams, participants, and clinicians could be improved. The third theme explored the personal impacts of contributing to research, with interviewees recalling common positive experiences. The final theme discussed capturing research impacts. Interviewees highlighted potential priorities for different stakeholders, but emphasised that financial impacts should not be the sole factor. CONCLUSION Individuals who were involved in NMAHPP health research recalled positive experiences and reported good relationships with their research teams. They felt that their contributions were valued. Suggested strategies to optimise the research experience focused on simplifying documentation, clear signposting of the research activities involved, and feedback on the research findings. Routine sharing of relevant research data with clinicians was also recommended. Personal impacts included a deeper understanding of their health condition or health more broadly, and increased confidence interacting with healthcare and other professionals. These findings will be used to inform development of a framework to capture the impact of NMAHPP research.
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Affiliation(s)
- Lisa Newington
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Therapies, Imperial College Healthcare NHS Trust, London, United Kingdom
- * E-mail:
| | - Caroline M. Alexander
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Therapies, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Pippa Kirby
- Therapies, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rhia K. Saggu
- Therapies, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mary Wells
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Nursing Directorate, Imperial College Healthcare NHS Trust, London, United Kingdom
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Raschke N, Bradbury J, Yoxall J. Perceptions of research capacity in public health organisations: comparison of NSW metropolitan and non-metropolitan Local Health Districts. AUST HEALTH REV 2022; 46:746-755. [PMID: 36396128 DOI: 10.1071/ah22100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/14/2022] [Indexed: 11/19/2022]
Abstract
Objective The aims of this study were to explore and compare the perceptions of research capacity and culture (RCC) in metropolitan and non-metropolitan New South Wales (NSW) Local Health Districts (LHDs). Methods The Research Capacity and Culture Tool was delivered online to clinicians and health managers. A 10-point Likert scale of success or skill at organisational, team and individual level of research capacity was used. An independent t -test assessed differences in domain means between non-metropolitan and metropolitan LHDs. Results A total of 1243 participants responded. Responses to the survey indicated the perception of individual's research skills were greater than the perception of RCC at both the team and organisational levels. Participants from metropolitan locations had significantly higher mean scores across all three domains compared with non-metropolitan locations (P Conclusion Results indicated the perception of individual's research skills were greater than the team and organisational levels. Participants from metropolitan locations had significantly higher perceptions of RCC across all three domains compared with non-metropolitan locations. This was the largest study to date in Australia investigating RCC in NSW LHDs, and the first study to explore multiple professions across multiple organisations while comparing metropolitan and non-metropolitan settings. This research may inform targeted strategies for building research capacity in NSW LHDs.
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Affiliation(s)
- Nicole Raschke
- Mid North Coast Local Health District, Port Macquarie, NSW, Australia
| | - Joanne Bradbury
- Faculty of Health, Southern Cross University, Gold Coast, Qld, Australia
| | - Jacqui Yoxall
- Faculty of Health, Southern Cross University, Gold Coast, Qld, Australia
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Piper D, Jorm C, Iedema R, Goodwin N, Searles A, McFayden L. Relational aspects of building capacity in economic evaluation in an Australian Primary Health Network using an embedded researcher approach. BMC Health Serv Res 2022; 22:813. [PMID: 35733164 PMCID: PMC9219146 DOI: 10.1186/s12913-022-08208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Health organisations are increasingly implementing ‘embedded researcher’ models to translate research into practice. This paper examines the impact of an embedded researcher model known as the embedded Economist (eE) Program that was implemented in an Australian Primary Health Network (PHN) located in regional New South Wales, Australia. The site, participants, program aims and design are described. Insights into the facilitators, challenges and barriers to the integration of economic evaluation perspectives into the work of the PHN are provided. Methods The eE Program consisted of embedding a lead health economist on site, supported by offsite economists, part-time, for fifteen weeks to collaborate with PHN staff. Evaluation of the eE at the PHN included qualitative data collection via semi-structured interviews (N= 34), observations (N=8) and a field diary kept by the embedded economists. A thematic analysis was undertaken through the triangulation of this data. Results The eE Program successfully met its aims of increasing PHN staff awareness of the value of economic evaluation principles in decision-making and their capacity to access and apply these principles. There was also evidence that the program resulted in PHN staff applying economic evaluations when commissioning service providers. Evaluation of the eE identified two key facilitators for achieving these results. First, a highly receptive organisational context characterised by a work ethic, and site processes and procedures that were dedicated to improvement. Second was the development of trusted relationships between the embedded economist and PHN staff that was enabled through: the commitment of the economist to bi-directional learning; facilitating access to economic tools and techniques; personality traits (likeable and enthusiastic); and because the eE provided ongoing support for PHN projects beyond the fifteen-week embedding period. Conclusions This study provides the first detailed case description of an embedded health economics program. The results demonstrate how the process, context and relational factors of engaging and embedding the support of a health economist works and why. The findings reinforce international evidence in this area and are of practical utility to the future deployment of such programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08208-7.
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Affiliation(s)
- Donella Piper
- NSW Regional Health Partners, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Christine Jorm
- School of Public Health, University of Sydney, Sydney, Australia
| | - Rick Iedema
- Centre for Team-Based Practice & Learning in Health Care, King's College, London, UK
| | - Nicholas Goodwin
- Central Coast Research Institute for Integrated Care, University of Newcastle & Central Coast Local Health District, Newcastle, Australia
| | - Andrew Searles
- Health Research Economics, Hunter Medical Research Institute, Newcastle, Australia.,University of Newcastle, Newcastle, Australia
| | - Lisa McFayden
- NSW Regional Health Partners, Newcastle, Australia. .,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
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King O, West E, Lee S, Glenister K, Quilliam C, Wong Shee A, Beks H. Research education and training for nurses and allied health professionals: a systematic scoping review. BMC MEDICAL EDUCATION 2022; 22:385. [PMID: 35590359 PMCID: PMC9121620 DOI: 10.1186/s12909-022-03406-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/22/2022] [Indexed: 05/06/2023]
Abstract
BACKGROUND Research capacity building (RCB) initiatives have gained steady momentum in health settings across the globe to reduce the gap between research evidence and health practice and policy. RCB strategies are typically multidimensional, comprising several initiatives targeted at different levels within health organisations. Research education and training is a mainstay strategy targeted at the individual level and yet, the evidence for research education in health settings is unclear. This review scopes the literature on research education programs for nurses and allied health professionals, delivered and evaluated in healthcare settings in high-income countries. METHODS The review was conducted systematically in accordance with the Joanna Briggs Institute scoping review methodology. Eleven academic databases and numerous grey literature platforms were searched. Data were extracted from the included full texts in accordance with the aims of the scoping review. A narrative approach was used to synthesise findings. Program characteristics, approaches to program evaluation and the outcomes reported were extracted and summarised. RESULTS Database searches for peer-reviewed and grey literature yielded 12,457 unique records. Following abstract and title screening, 207 full texts were reviewed. Of these, 60 records were included. Nine additional records were identified on forward and backward citation searching for the included records, resulting in a total of 69 papers describing 68 research education programs. Research education programs were implemented in fourteen different high-income countries over five decades. Programs were multifaceted, often encompassed experiential learning, with half including a mentoring component. Outcome measures largely reflected lower levels of Barr and colleagues' modified Kirkpatrick educational outcomes typology (e.g., satisfaction, improved research knowledge and confidence), with few evaluated objectively using traditional research milestones (e.g., protocol completion, manuscript preparation, poster, conference presentation). Few programs were evaluated using organisational and practice outcomes. Overall, evaluation methods were poorly described. CONCLUSION Research education remains a key strategy to build research capacity for nurses and allied health professionals working in healthcare settings. Evaluation of research education programs needs to be rigorous and, although targeted at the individual, must consider longer-term and broader organisation-level outcomes and impacts. Examining this is critical to improving clinician-led health research and the translation of research into clinical practice.
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Affiliation(s)
- Olivia King
- Western Alliance, 25 Ryot St, Warrnambool, 3280, VIC, Australia.
- Barwon Health, Geelong, VIC, Australia.
- Monash University, Clayton, VIC, Australia.
| | - Emma West
- Western Alliance, 25 Ryot St, Warrnambool, 3280, VIC, Australia
- Deakin University, Geelong, VIC, Australia
| | - Sarah Lee
- Monash University, Clayton, VIC, Australia
| | - Kristen Glenister
- The University of Melbourne, Wangaratta and Shepparton, VIC, Australia
| | - Claire Quilliam
- The University of Melbourne, Wangaratta and Shepparton, VIC, Australia
| | - Anna Wong Shee
- Deakin University, Geelong, VIC, Australia
- Grampians Health, Ballarat, VIC, Australia
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Martin E, Fisher O, Merlo G, Zardo P, Barrimore SE, Rowland J, Davies JM. Impact of a health services innovation university program in a major public hospital and health service: a mixed methods evaluation. Implement Sci Commun 2022; 3:46. [PMID: 35468818 PMCID: PMC9036712 DOI: 10.1186/s43058-022-00293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background While health services and their clinicians might seek to be innovative, finite budgets, increased demands on health services, and ineffective implementation strategies create challenges to sustaining innovation. These challenges can be addressed by building staff capacity to design cost-effective, evidence-based innovations, and selecting appropriate implementation strategies. A bespoke university award qualification and associated program of activities was developed to build the capacity of staff at Australia’s largest health service to implement and evaluate evidence-based practice (EBP): a Graduate Certificate in Health Science majoring in Health Services Innovation. The aim of this study was to establish the health service’s pre-program capacity to implement EBP and to identify preliminary changes in capacity that have occurred as a result of the Health Services Innovation program. Methods A mixed methods design underpinned by the Consolidated Framework for Implementation Research informed the research design, data collection, and analysis. Data about EBP implementation capacity aligned to the framework constructs were sought through qualitative interviews of university and health service executives, focus groups with students, and a quantitative survey of managers and students. The outcomes measured were knowledge of, attitudes towards, and use of EBP within the health service, as well as changes to practice which students identified had resulted from their participation in the program. Results The Health Services Innovation program has contributed to short-term changes in health service capacity to implement EBP. Participating students have not only increased their individual skills and knowledge, but also changed their EPB culture and practice which has ignited and sustained health service innovations and improvements in the first 18 months of the program. Capacity changes observed across wider sections of the organization include an increase in connections and networks, use of a shared language, and use of robust implementation science methods such as stakeholder analyses. Conclusion This is a unique study that assessed data from all stakeholders: university and health service executives, students, and their managers. By assembling multiple perspectives, we identified that developing the social capital of the organization through delivering a full suite of capacity-building initiatives was critical to the preliminary success of the program. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00293-3.
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Affiliation(s)
- Elizabeth Martin
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
| | - Olivia Fisher
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Gregory Merlo
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Primary Care Clinical Unit, School of Clinical Medicine, University of Queensland (UQ), St Lucia, Queensland, Australia
| | - Pauline Zardo
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Sally E Barrimore
- Nutrition and Dietetics Department, The Prince Charles Hospital, Metro North Health, Chermside, Queensland, Australia
| | - Jeffrey Rowland
- Internal Medicine, The Prince Charles Hospital, Metro North Health, Chermside, Queensland, Australia
| | - Janet M Davies
- Metro North Health, and Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Reen G, Page B, Oikonomou E. Working as an embedded researcher in a healthcare setting: A practical guide for current or prospective embedded researchers. J Eval Clin Pract 2022; 28:93-98. [PMID: 34121278 DOI: 10.1111/jep.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Gurpreet Reen
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Eirini Oikonomou
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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An Integrated Care Strategy for Pre-schoolers with Suspected Developmental Disorders: The Optimus Co-design Project that has Made it to Regular Care. Int J Integr Care 2021; 21:3. [PMID: 33953649 PMCID: PMC8051154 DOI: 10.5334/ijic.5494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Multiple neurodevelopmental problems affect 7–8% of children and require evaluation by more than one profession, posing a challenge to care systems. Description: The local problem comprised distressed parents, diagnostic processes averaging 36 months and 28 visits with 42% of children >4 years at referral to adequate services, and no routines for patient involvement. The co-design project was developed through a series of workshops using standard quality improvement methodology, where representatives of all services, as well as parents participated. The resulting integrated care model comprises a team of professionals who evaluate the child during an average of 5.4 appointments (N = 95), taking 4.8 weeks. Parents were satisfied with the holistic service model and 70% of children were under 4 at referral (p < 0.05). While 75% of children were referred, 25% required further follow-up by the team. Discussion: The Optimus model has elements of vertical, clinical and service integration. Reasons for success included leadership support, buy-in from the different organisations, careful process management, a team co-ordinator, and insistent user involvement. Conclusion: Evaluating multiple neurodevelopmental problems in children requires an integrated care approach. The Optimus care model is a relevant showcase for how people-initiated integrated care reforms can make it into usual care.
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