Rehabilitation - Department of Paediatrics & Adolescent...
Transcript of Rehabilitation - Department of Paediatrics & Adolescent...
1
Rehabilitation Institutional Care & Community Care
© Copyright 2009
RehabilitationRehabilitationInstitutional Care & Community CareInstitutional Care & Community Care
Eliza WONGEliza WONG28 Mar 200928 Mar 2009
ContentContent
Definition of rehabilitationDefinition of rehabilitationHistory and development of History and development of rehabilitative service in HKrehabilitative service in HKPaediatricPaediatric rehabilitationrehabilitationHospital care VS community careHospital care VS community careCase sharingCase sharing
RehabilitationRehabilitation
Enable people with disabilities to Enable people with disabilities to reach and maintain optimal physical, reach and maintain optimal physical, sensory, intellectual, psychological sensory, intellectual, psychological and / or social functionand / or social function
WHOWHO
Evolution of Rehabilitation Concept (HK)Evolution of Rehabilitation Concept (HK)
Early Stage (before 1950)Early Stage (before 1950)Piece mealPiece mealBy charitable bodies and voluntary By charitable bodies and voluntary agenciesagenciesTemporary assistanceTemporary assistance
1950 1950 -- 19701970More systematicMore systematicGovernment supportGovernment supportProvide training etc.Provide training etc.
Development of Rehabilitation PolicyDevelopment of Rehabilitation PolicyYear of 1977 Year of 1977 ---- White Paper on White Paper on Rehabilitation Rehabilitation –– Integrated the Integrated the Disabled into the CommunityDisabled into the Community
Year of 1995 Year of 1995 ---- White Paper on White Paper on Rehabilitation Rehabilitation –– Equal Opportunities and Equal Opportunities and Full Participation for Disabled Full Participation for Disabled
Evolution of Rehabilitation Concept (HK)Evolution of Rehabilitation Concept (HK)
Policy Formulation & CoPolicy Formulation & Co--ordination of ordination of ServicesServices
The The LabourLabour & Welfare Bureau & Welfare Bureau Review & coReview & co--ordinate with Government ordinate with Government Dept. & NGODept. & NGOStrategic direction & priorities for Strategic direction & priorities for rehabilitation policies and servicesrehabilitation policies and services
Development of Rehabilitation PolicyDevelopment of Rehabilitation Policy
2
Rehabilitation Institutional Care & Community Care
© Copyright 2009
Policy Objective for Rehabilitation (HK)Policy Objective for Rehabilitation (HK)
Preventive MeasurePreventive MeasureHelp persons with disabilities develop their Help persons with disabilities develop their physical, mental, and social capabilities to physical, mental, and social capabilities to the fullest extent which their disability the fullest extent which their disability permitspermitsDesign on Barrier Free AccessDesign on Barrier Free Access
To ensure their overall well being, inclusion in the To ensure their overall well being, inclusion in the community and achieve the common mission community and achieve the common mission ““equal equal opportunities and full participationopportunities and full participation””
Rehabilitation Services (HK)Rehabilitation Services (HK)
Prevention & Early IdentificationPrevention & Early IdentificationSpecial Education & TrainingSpecial Education & TrainingVocational RehabilitationVocational RehabilitationMedical RehabilitationMedical RehabilitationSocial Rehabilitation ServicesSocial Rehabilitation ServicesHousing, Residential CareHousing, Residential CareTransport, Access FacilitiesTransport, Access FacilitiesWelfare AllowanceWelfare AllowanceSports & RecreationSports & Recreation
Improve the functional abilityImprove the functional abilityPromote independence Promote independence Promote quality of lifePromote quality of lifeBack to the communityBack to the community
Goal of RehabilitationGoal of Rehabilitation
What about Children?What about Children?
Growth and DevelopmentGrowth and Development
Normal development is a function of Normal development is a function of the maturity of the nervous system the maturity of the nervous system
and on experiencesand on experiences
3
Rehabilitation Institutional Care & Community Care
© Copyright 2009
Problem of Interference of Normal Problem of Interference of Normal Maturation of the Brain by the LesionMaturation of the Brain by the Lesion
Retardation or arrest of normal Retardation or arrest of normal developmentdevelopmentNumerous aspects of disabilities Numerous aspects of disabilities
LanguageLanguage
EpilepsyEpilepsy
FeedingFeeding Vision & Vision & HearingHearing
MobilityMobilityLearning Learning difficultydifficulty
Cerebral Palsy
World Health Organization World Health Organization (ICF)(ICF)
IInternational nternational CClassification of lassification of FFunctioning, Disability, and unctioning, Disability, and HealthHealth
A model to guide clinical thinking, A model to guide clinical thinking, practice for children with practice for children with developmental disabilitiesdevelopmental disabilities
International Classification of International Classification of Functioning, Disability & Health (ICF)Functioning, Disability & Health (ICF)
Health conditionHealth condition(Disorder or disease)(Disorder or disease)
ICDICD--1010
Body functions/StructureBody functions/Structure(Impairment)(Impairment)
ActivityActivity(Disability)(Disability)
ParticipationParticipation(Handicap)(Handicap)
Environmental Factors
Personal Factors
Health ConditionHealth Condition
Cerebral PalsyCerebral Palsy
ActivitiesActivitiesMobilityMobility
Self Self ––carecareObject manipulationObject manipulation
Written communicationWritten communication
ImpairmentImpairmentSkeletal alignmentSkeletal alignmentRange of motionRange of motion
Muscle performanceMuscle performanceFitnessFitness
ParticipationParticipationInvolvement in home life, Involvement in home life,
education, community education, community event and social event and social
relationshiprelationship
Personal FactorsPersonal FactorsAgeAge
GenderGenderInterestInterest
PersonalityPersonalitySelfSelf--EfficacyEfficacy
Environmental Environmental FactorsFactors
AccessibilityAccessibilityAccommodationAccommodationPhysical supportPhysical support
Emotional supportEmotional supportPalisanoPalisano et al 2004et al 2004
Assessment of a Child with DisabilityAssessment of a Child with Disability
Knowledge of normal growth Knowledge of normal growth pattern functional milestones and pattern functional milestones and potential deviation is important to potential deviation is important to the comprehensive management of the comprehensive management of children with developmental or children with developmental or acquired disabilities acquired disabilities
Milestone in Child DevelopmentMilestone in Child Development
4
Rehabilitation Institutional Care & Community Care
© Copyright 2009
3 months3 monthsSupports on forearms in proneSupports on forearms in proneHold head up steadilyHold head up steadilyHands open restHands open restCoosCoosAnticipates feedingAnticipates feedingFollows in circular fashionFollows in circular fashion
Milestone in Child DevelopmentMilestone in Child Development
6 months6 months
Sits well unsupportedSits well unsupportedReaches with either hand; Transfers Reaches with either hand; Transfers cubescubesBabblesBabblesSense of belonging to a central personSense of belonging to a central person
Milestone in Child DevelopmentMilestone in Child Development
2 years2 years
Walks up and down stairs aloneWalks up and down stairs aloneTurns one page; Imitates vertical strokeTurns one page; Imitates vertical strokeUses 2 word sentenceUses 2 word sentenceFeeds doll with bottleFeeds doll with bottleBegins toilet trainingBegins toilet training
Milestone in Child DevelopmentMilestone in Child Development3 years3 years
Pedals tricyclePedals tricycleUp and stairs alternate feetUp and stairs alternate feetCopies circleCopies circleUses 3 word sentence. Uses 3 word sentence. Minimum 250 wordsMinimum 250 wordsKnows age, sexKnows age, sexGroup playGroup play
Milestone in Child DevelopmentMilestone in Child Development
4 years4 years
Hops, skipsHops, skipsCatches ball with handsCatches ball with handsKnow Know colourscolours, ask question, ask questionButton clothsButton clothsPlay well in groupPlay well in group
Milestone in Child DevelopmentMilestone in Child Development5 years5 years
Jumps over low obstaclesJumps over low obstaclesDraws man with all body partsDraws man with all body partsFluent speechFluent speechPlays competitive gamesPlays competitive games
Milestone in Child DevelopmentMilestone in Child Development
5
Rehabilitation Institutional Care & Community Care
© Copyright 2009
7 years7 years
Continue refinement of skillsContinue refinement of skillsEats with fork and spoonEats with fork and spoonSelf groomingSelf groomingFact Vs fictionFact Vs fiction
Milestone in Child DevelopmentMilestone in Child DevelopmentAdolescenceAdolescence
Skills refinedSkills refinedAbstract thoughts/ hypothesisAbstract thoughts/ hypothesisStage of identity Vs role confusionStage of identity Vs role confusion““GroupGroup”” identityidentity
Milestone in Child DevelopmentMilestone in Child Development
PaediatricPaediatric RehabilitationRehabilitation
Acquired Acquired DisabilitiesDisabilities
(Trauma / (Trauma / Disease)Disease)
Congenital Congenital
Disabilities Disabilities (Congenital(Congenital
Origin)Origin)
Common Congenital DisabilitiesCommon Congenital Disabilities
Cerebral palsyCerebral palsyMental retardationMental retardationSpinal bifidaSpinal bifidaJoint diseaseJoint diseaseSkeletal disorderSkeletal disorderNeuromuscular diseaseNeuromuscular diseaseNeurometabolicNeurometabolic diseasedisease
Common Acquired DisabilitiesCommon Acquired Disabilities
Head InjuryHead InjurySpinal cord injurySpinal cord injuryBrain injury/ Surgical Brain injury/ Surgical interventionsinterventionsBurnsBurnsAmputationsAmputations
Functional DisabilitiesFunctional Disabilities
Visual problemVisual problem
BlindnessBlindness
Low visionLow vision
6
Rehabilitation Institutional Care & Community Care
© Copyright 2009
Functional DisabilitiesFunctional Disabilities
Hearing problemHearing problemFeeding problemFeeding problemLearning difficultiesLearning difficultiesAttention deficitAttention deficitAutisticAutistic
Care & Management for Care & Management for
Children with DisabilitiesChildren with Disabilities
ReRe--HabilitationHabilitation
Habilitation Habilitation
Rehabilitation Vs HabilitationRehabilitation Vs Habilitation
Acquired physical Acquired physical disabilitydisability
Loss of previously Loss of previously mastered skillsmastered skillsRestoration of lost Restoration of lost functionfunction
Congenital Congenital anomalies, anomalies, neuroneuro--developmental developmental delaydelay……Do not have normal Do not have normal abilities early in abilities early in lifelifeAcquisition of new Acquisition of new function function
RehabilitationRehabilitation HabilitationHabilitation
Relearn of previous Relearn of previous skills. In essence, skills. In essence, management of management of changechangeRequire Require adjustment to adjustment to alter functional alter functional ability and life ability and life stylestyle
Develop new skills to Develop new skills to enable to function enable to function within given within given environmentenvironmentDevelop new skills to Develop new skills to achieve maximum achieve maximum potential potential
RehabilitationRehabilitation HabilitationHabilitation
Rehabilitation Vs HabilitationRehabilitation Vs Habilitation
Uniqueness of Uniqueness of PaediatricPaediatricHabilitation/RehabilitationHabilitation/Rehabilitation
Concept of plasticity of Concept of plasticity of childrenchildren’’s brainss brains
Focus on developmentally Focus on developmentally & functional abilities & functional abilities
support caresupport carePromotion of familyPromotion of family--centredcentred carecare
Concept of Plasticity of Concept of Plasticity of ChildrenChildren’’s Brainss Brains
Early intervention Early intervention improve improve outcomeoutcomePeriodical rePeriodical re--evaluation, regular evaluation, regular interval assessment interval assessment update the update the status of childrenstatus of childrenPlanning and intervention rePlanning and intervention re--adjustment adjustment changing needs changing needs
7
Rehabilitation Institutional Care & Community Care
© Copyright 2009
Promotion of FamilyPromotion of Family--CentredCentred CareCare
Child Child integral part of a familyintegral part of a familyHome Home central focus of a childcentral focus of a child’’s s worldworldCoCo--ordination of care, with family ordination of care, with family as part of healthcare teamas part of healthcare team
Assist family share an important Assist family share an important role in shaping the childrole in shaping the child’’s futures future
Focus on Developmentally and Functional Focus on Developmentally and Functional Abilities Support CareAbilities Support Care
Assessing childrenAssessing children’’s developmental profile s developmental profile (current development in physical, cognitive, (current development in physical, cognitive, social and emotion)social and emotion)Assessing childrenAssessing children’’s functional abilities s functional abilities (understanding what a child actually does)(understanding what a child actually does)Planning creative strategies Planning creative strategies ------ address on address on unique developmental needsunique developmental needsPredict and planning short term/long term Predict and planning short term/long term realistic goals realistic goals
The Child & The Child & family with family with
Special needsSpecial needs
Health Care Services:Health Care Services:
•• Preventive measurePreventive measure•• MultiMulti--disciplinary disciplinary Rehabilitation TeamRehabilitation Team
Social Welfare Social Welfare DepartmentDepartment
Non Non Government Government Organization Organization
Education Department Education Department BureauBureau
PaediatricPaediatric Rehabilitation Services in Rehabilitation Services in Hong KongHong Kong Preventive MeasurePreventive Measure
AnteAnte--natal Care (early detection of natal Care (early detection of abnormality, genetic study)abnormality, genetic study)
Child Health & Development SurveillanceChild Health & Development Surveillance
Child Assessment CentreChild Assessment Centre
Child Assessment Child Assessment CentreCentre
PaediatricPaediatricNeurology/Neurology/NeuroNeuro--
rehabilitation Wardrehabilitation Ward
Child Assessment CentreReferral request from other Agency Assessment Clinic
Further Assessment by Team Member
Investigation
School Placement Treatment/Training program
Case Conference / pre-admission Conference
Follow-up arrangement
No? Ready for discharge
Yes
8
Rehabilitation Institutional Care & Community Care
© Copyright 2009
Social Welfare DepartmentSocial Welfare Department-- Central Central Referral SystemReferral System
Integrated Child Care Centre Integrated Child Care Centre (ICCC)(ICCC) Special Child Care Centre Special Child Care Centre (SCCC)(SCCC) Early Educational Training Centre Early Educational Training Centre (EETC)(EETC)
PrePre--school Servicesschool Services
Primary & Secondary EducationPrimary & Secondary Education Education Department Bureau Education Department Bureau ––
Special Education SectionSpecial Education Section Special SchoolSpecial School Remedial ClassRemedial Class Resource SupportResource Support
Hospital / Institutional CareHospital / Institutional CareHospital / Institutional Care
Community CareCommunity Care
Pulmonary Rehabilitation ProgramPulmonary Rehabilitation ProgramRegular periodical monitoring of pulmonary function Regular periodical monitoring of pulmonary function
for patients with for patients with neuroneuro--muscular diseasemuscular disease
Sleep study Sleep study SpO2 monitoring, LFT, Blood GasSpO2 monitoring, LFT, Blood GasArrangement of equipments if ventilator support Arrangement of equipments if ventilator support is initiated as well as patient / parent trainingis initiated as well as patient / parent trainingVentilator (Ventilator (BiPAPBiPAP / CPAP) titration/ CPAP) titrationSupport for chest maintenanceSupport for chest maintenance
Manage patients with multiple disabilities / Manage patients with multiple disabilities / high dependency level / complex medical & high dependency level / complex medical & rehabilitative needsrehabilitative needs
Family centered approachFamily centered approachFacilitate parent as equal partners in the Facilitate parent as equal partners in the caring and managing of childrencaring and managing of children
Intermediate Care / Step Down Care Intermediate Care / Step Down Care with Rehabilitation Programwith Rehabilitation Program
Rehabilitation TeamRehabilitation Team Framework of Rehabilitation NursingFramework of Rehabilitation Nursing
Education Education
CoCo--ordinationordination
TherapeuticTherapeuticPracticePractice
AdvocacyAdvocacy
Advice / Advice / CounselingCounseling
Empowerment Empowerment
9
Rehabilitation Institutional Care & Community Care
© Copyright 2009
Common Disability Common Disability ––Feeding ProblemFeeding Problem
Hindrance to FeedingHindrance to FeedingInability to sit independently in an Inability to sit independently in an upright positionupright position
Poor head controlPoor head controlPoor trunk controlPoor trunk controlInvoluntary movements Involuntary movements
Hindrance to FeedingHindrance to FeedingAn exaggeration of normal feeding An exaggeration of normal feeding skillskill
Tonic bite reflexTonic bite reflexTongue retractionTongue retractionHyperactive gag reflexHyperactive gag reflex
Hindrance to FeedingHindrance to FeedingPoor coordination of the Jaw, Lip, and Poor coordination of the Jaw, Lip, and TongueTongue
Poor lip closure Poor lip closure Poorly controlled tongue movementPoorly controlled tongue movementPoor chewing patternPoor chewing pattern
Hindrance to FeedingHindrance to FeedingA delay in the normal progression of A delay in the normal progression of feeding skillsfeeding skills
Inability to grasp food or to finger Inability to grasp food or to finger feedfeedDifficulty in cup drinkingDifficulty in cup drinkingDifficulty using a spoonDifficulty using a spoon
OralOral--Motor Rehabilitation Motor Rehabilitation ProgramProgram
Video Fluoroscopy Swallowing Study Video Fluoroscopy Swallowing Study (VFSS)(VFSS)24 Hours PH Study24 Hours PH Study
10
Rehabilitation Institutional Care & Community Care
© Copyright 2009
OralOral--Motor Rehabilitation Motor Rehabilitation ProgramProgram
Feeding trainingFeeding training
Monitor of growth & nutritional status Monitor of growth & nutritional status Monitor signs of aspirationMonitor signs of aspirationEnsure safe feeding regimeEnsure safe feeding regimeAdjust food consistencyAdjust food consistencyRyleRyle’’ss tube feeding / tube feeding / GastrostomyGastrostomy carecare
Common Disability Common Disability --EpilepsyEpilepsy
Epilepsy Rehabilitation ProgramEpilepsy Rehabilitation Program
••
VEEG monitoring VEEG monitoring Seizure monitoring & Drug titrationSeizure monitoring & Drug titrationPost epilepsy surgery rehabilitationPost epilepsy surgery rehabilitationParent educationParent education
Emergency managementEmergency managementKetogenicKetogenic dietdietDrug regimeDrug regime
Upper airway abnormalities Upper airway abnormalities Craniofacial syndromeCraniofacial syndromeMucopolysaccharidosisMucopolysaccharidosisDown syndromeDown syndromeSkeletal dysplasia Skeletal dysplasia e.ge.g achondroplasiaachondroplasiaSpinal muscular atrophySpinal muscular atrophyCongenital Congenital myopathymyopathyCongenital Congenital hypoplastichypoplastic lunglung
MMeedical Conditions for dical Conditions for TracheostomyTracheostomy/ / Long term ventilator AssistedLong term ventilator Assisted
A youth, stayed few years in Intensive Care Unit..A youth, stayed few years in Intensive Care Unit..………………....Something can be doneSomething can be done……....
Children born with Muscle diseaseChildren born with Muscle disease--Dependent on wheel chair for Dependent on wheel chair for mobilitymobility--Need machine to assist breathingNeed machine to assist breathingFamily has difficulty looking afterFamily has difficulty looking after A HDU case A HDU case –– a Child hook a Child hook
on Ventilator since 3 on Ventilator since 3 months oldmonths old……
11
Rehabilitation Institutional Care & Community Care
© Copyright 2009
InIn--patient Step Down Care for patient Step Down Care for Assisted Long Term VentilationAssisted Long Term Ventilation
ICU, HDUICU, HDU
Rehab Ward - Ventilator Care Program
HomeHome
SchoolSchoolSociety
Family orientedFamily orientedPatient / care taker empowerPatient / care taker empower
Can They Allow Home Care ?Can They Allow Home Care ?
Hindrance to Discharge/Community Hindrance to Discharge/Community IntegrationIntegration
Incompetent parents Incompetent parents Problem in recruitment of trained Problem in recruitment of trained carerscarers
ParentParent’’s acceptance of shoulder the power s acceptance of shoulder the power shifting shifting
Social implicationSocial implicationOffended by reactions faced Offended by reactions faced Living isolatedLiving isolated
Environmental factorsEnvironmental factors
Hindrance to Hindrance to Discharge/Community IntegrationDischarge/Community Integration
Confronting parental responsibilityConfronting parental responsibilityImpact on family relationshipImpact on family relationship-- Need devoted extraordinary care and attention Need devoted extraordinary care and attention
to childto child’’s need s need -- SiblingSibling’’s resentment towards of being neglecteds resentment towards of being neglectedSingle parentsSingle parentsFamily stressFamily stress
-- Living with daily threat of deathLiving with daily threat of death-- Worry of childWorry of child’’s transition to adult lifes transition to adult life
Hindrance to Hindrance to Discharge/Community IntegrationDischarge/Community Integration
Pave the Road HomePave the Road Home
Most important considerationMost important consideration
When to startWhen to start
How to startHow to start
12
Rehabilitation Institutional Care & Community Care
© Copyright 2009
When to StartWhen to Start
Medical condition stableMedical condition stable
Psychological preparation for Psychological preparation for parentsparents
Allow times for parents to Allow times for parents to digest the rehabilitation plandigest the rehabilitation plan
Identification of Identification of carerscarersShared decision makingShared decision makingParental empowermentParental empowermentOpen communicationOpen communication
How to StartHow to Start
Pave the Road HomePave the Road HomePrePre--transfer screeningtransfer screening
Build up rapportBuild up rapportAssess complexity patientAssess complexity patient’’s statuss statusMatch patientMatch patient’’s need with available s need with available resources resources Understand and communicate Understand and communicate both expectations both expectations
-- Resource & manpower in care is explainedResource & manpower in care is explained-- Treatment available at different stage Treatment available at different stage
is made knownis made known-- Stages of pulmonary decline should be explainedStages of pulmonary decline should be explained-- Formulate rehabilitation planFormulate rehabilitation plan
PrePre--discharge planningdischarge planning
Initiate the rehabilitation and Initiate the rehabilitation and educational program for educational program for carerscarerswith set time frame with set time frame Periodical progress meeting Periodical progress meeting
with parent / with parent / carercarerHome visit & home leave planHome visit & home leave plan
Pave the Road HomePave the Road Home
Environmental Adaptation & Home Environmental Adaptation & Home TrainingTraining
Identify the environmental Identify the environmental barriers of living environmentbarriers of living environmentIntegrate child into society & Integrate child into society & discharge home safelydischarge home safely
Pave the Road HomePave the Road Home
A Case StudyA Case Study
SMA Child discharged home SMA Child discharged home
with invasive ventilator supportwith invasive ventilator support
13
Rehabilitation Institutional Care & Community Care
© Copyright 2009
Rehabil itation Program and
Discharge Plan for SMA Child
w i th Invas i ve Vent i l a t i o n
Identification of Care TakerIdentification of Care Taker
@ Mother@ Maid @ Father
Communication & Collaboration Communication & Collaboration
•• Formulate the master training Formulate the master training program is very important and with program is very important and with the time framethe time frame
•• Periodical case conference is needed Periodical case conference is needed so that the team members and the so that the team members and the parents had mutual agreement on the parents had mutual agreement on the discharge plandischarge plan
Speech therapistSpeech therapist
- Use of speaking valve Use of speaking valve -- Communication Communication -- OroOro--motor functionmotor function
PhysiotherapistPhysiotherapist
– Chest maintenanceChest maintenance–– Suction techniquesSuction techniques–– Care of suction machineCare of suction machine–– Limb exerciseLimb exercise
Occupational therapistOccupational therapist
-- TransferTransfer-- Wheelchair setting with ventilator Wheelchair setting with ventilator
& external battery& external battery-- Home modificationHome modification
14
Rehabilitation Institutional Care & Community Care
© Copyright 2009
Medical social workerMedical social worker
- Funding applicationFunding application-- Financial assessment Financial assessment -- ReRe--housing housing -- Solve the family conflictSolve the family conflict
Clinical psychologistClinical psychologist
- Psychological preparation Psychological preparation -- Solve some family conflictSolve some family conflict
NurseNurse
-- GastrostomyGastrostomy care care -- TracheostomyTracheostomy carecare-- Ventilator care Ventilator care -- Use of manual resuscitatorUse of manual resuscitator-- Prepare patient for outing / Prepare patient for outing /
home leavehome leave-- Solve familySolve family’’s conflicts conflict
The Go BagThe Go Bag
-- For emergencyFor emergency* Spare same size & down size* Spare same size & down size
tracheostomytracheostomy tubestubes* Tracheal dilator* Tracheal dilator* Suction tubes* Suction tubes* Resuscitator* Resuscitator
Outing StrategyOuting Strategy-- ParentParent’’s education program completed & passeds education program completed & passed-- Patient outing with parentsPatient outing with parents
* with nurse escort for few times* with nurse escort for few times* without nurse * without nurse
-- Patient outing Patient outing * within hospital compound* within hospital compound* outside hospital area* outside hospital area
Step Down ApproachStep Down Approach
- ParentParent’’s skills and confidence build up s skills and confidence build up in escorting the outingin escorting the outing
-- Try day home leaveTry day home leave-- Home visit by team membersHome visit by team members-- Home modification will be proceed Home modification will be proceed -- Plan for overnight home leavePlan for overnight home leave
15
Rehabilitation Institutional Care & Community Care
© Copyright 2009
Preparation for Overnight Home LeavePreparation for Overnight Home Leave
-- Concrete daily schedule need to offer Concrete daily schedule need to offer to care takerto care taker
-- Back up machine if the child had no Back up machine if the child had no unplug timeunplug time
-- Letter to the A&E department in case Letter to the A&E department in case of crisisof crisis
Facilitate Discharge PlanFacilitate Discharge Plan
- Arrange mother to stay overnight in Arrange mother to stay overnight in mother and child room to facilitate mother and child room to facilitate overnight home leaveovernight home leave
-- Assess motherAssess mother’’s skill s skill -- Solve problems arising during the Solve problems arising during the
staystay
Work on Equipment ListWork on Equipment List
- Essential equipment listEssential equipment list-- For funding application For funding application -- Or rent to own schemeOr rent to own scheme
Other PreparationOther Preparation
-- Estimate monthly Estimate monthly consumption consumption
-- Purchasing list of the Purchasing list of the essential consumable items essential consumable items
Other Back Up ServicesOther Back Up Services
-- CNS serviceCNS service* Monitor of progress* Monitor of progress* Psychological support* Psychological support
-- 24 hours hot line enquiry from ward24 hours hot line enquiry from ward-- Respite careRespite care
Discharged Home
16
Rehabilitation Institutional Care & Community Care
© Copyright 2009
HospitalHospital CommunityCommunity –– Home, Social Activity, Home, Social Activity, Leisure, SchooLeisure, Schooll
Community Support Networking in HK Community Support Networking in HK
Education Department BureauEducation Department BureauSocial Welfare DepartmentSocial Welfare DepartmentCommunity nursingCommunity nursingHousing Housing TransportTransportEmergency attentionEmergency attentionEmployment Employment
Our WishesOur Wishes………………....
Children with chronic Children with chronic disabilities be able to disabilities be able to grow up in a supportive & grow up in a supportive & loving environmentloving environmentThey are able to grasp They are able to grasp
their strength their strength and abilitiesand abilitiesContributing to the society Contributing to the society
and be part ofand be part ofthe communitythe community