IMPLEMENTING RBM IN MEDICAL SETTINGS: WHAT WE HAVE LEARNED FROM IT ?

Y.-L. Pan^1,2, H.-C. Hsu^1,2, Y.-C. Lee^1,2, A.-A. Cheng^2,3, M.-R. Tsai^2,4, L. Lu^1,2, J.-Y. Shieh^1,2, H.-F. Liao⁵, A.-W. Hwang⁶, R.A. McWilliam⁷

Background: Routines-Based Model (RBM) is a practical model of early childhood intervention based on family-centered concepts. However, the RBM model is mainly developed based on the structure of the early intervention system in the United States, for family or classroom visits; the implementation experience in Taiwan was mostly in the field of social welfare and education systems, with limited experience in the medical settings.

Purpose: This research is a preliminary report of the implementation of RBM's Routines-Based Interview Plus (RBI+), Comprehensive Service Provider (CSP) and Goal Attainment Scale (GAS) in the Child Developmental Assessment & Intervention Center (CDAIC), National Taiwan University Hospital, including team formation, team operations, preliminary results and experience reviews.

Methods: A task force group in the CDAIC started to deliver experimental RBM services since June 2018. The arena assessment was used to understand the development of the child,  and the Parental Stress Inventory (PSI) and Family Outcome Survey (FOS) were filled by parents to understand potential family needs. The RBI+ was delivered, and goals and were set together with the parents with six-month interval, with the Goal Attainment Scale (GAS). Each child and family had a CSP who supported parents to achieve their goals through collaborative consultation. The CSP checked goals attainment with parents at midterm and the end of six months, and held a team meeting with parents to review the progress.

Results: Within 2 years, 10 children and families, with a total of 14 Individualized Service Plans (ISP) have been completed. Each plan had 8-13 goals, including child participation goals and family goals. For the children and family outcomes, 4-10 goals in the ISP were met or exceed the expected outcomes; the GAS target behavior achievement rate averages 72% (36-100%), and the score achievement rate averages 64% (37 -88%). PSI and FOS showed that difficulties/needs of parents and family were also improved. For the professional outcomes, the team experienced role release on team members, mutual learning for professional collaboration, the transformation from traditional direct treatment to collaborating with parents, family empowerment and enablement, etc. The factors that influenced the effectiveness and implementation process including: 1). Professional related factors: CSP's ability are still not proficient was the main influencing factor, and they have not used of Intervention Matrix and Next-Step Form, and did not follow the standard procedure of the Routines-Based Clinic Service Checklist. In addition, whether CSP meet the family regularly, relationship with parents, and the interruption of services during the period of Covid-19 may also affect the outcome. 2). Child and family-related factors: changes of children's body function due to medical treatment, changes of caregivers and transitions, etc..

Conclusion(s): It is feasible and beneficial for children, families and professionals to apply some components of the RBM model in the field of medical settings.

Implications: Preliminary evidence of implementing the RBM model in medical settings was provided at the theoretical and technical level. Full implementation still needs to overcome challenges of policies, administrative systems, economic costs and the training of professionals with sustainable plans.

Funding, acknowledgements: none

Keywords: RBM model, Comprehensive Service Provider, Medical Settings

Topic: Paediatrics

Did this work require ethics approval? No

Institution: none

Committee: none

Reason: The research described a new development in early intervention practice in Taiwan. The proposal and ethics approval are now in preparation.