Health Services

Led by Professor Harriet Hiscock, the Health Services Group supports the development and use of the best available evidence to increase the quality, accessibility, and value of healthcare that children receive. It aims to reduce disparities and to improve health outcomes for children across Victoria and Australia. With the growing cost and demand for health services and the complexity of health care delivery, health services research can better inform policy makers, clinicians and patients on how best to deliver healthcare.

Health Services Research is a scientific field that examines:

  • How people get access to healthcare
  • How much care costs
  • What happens to patients as a result of this care.

Our research investigates how to improve children’s mental health care through clinical and population trials and studies of the organisation and financing of mental health care. We work in partnership with the Royal Children’s Hospital Health Services Research Unit which focuses on developing and testing novel approaches to shift care from the overburdened hospital system to the community and to reduce low value or wasteful care.

Our work is underpinned by systematic reviews, secondary healthcare data analysis and large, epidemiological studies. Health services research, quality improvement and health economics perspectives are integral to our work.

Group Leaders: 
Group Members: 
Alex Dawson
Role: 
Research Assistant
Alexa Chalmers
Role: 
Research Assistant
Alisha Gulenc
Role: 
Research Assistant
Anthea Rhodes
Role: 
PhD Student
Ann-Siobhan Connolly
Role: 
Research Assistant
Bethany Crocker
Role: 
Honours Student – CAP
Cate Rayner
Role: 
Paediatric Fellow
Dafna Idan Prusak
Role: 
Research Assistant
A/Prof Daryl Efron
Role: 
Senior Research Fellow
Daniella Joshua
Role: 
MDRP Student - CAP
Dr Emma Sciberras
Role: 
Honorary Research Fellow
Ella Sexton
Role: 
Masters Student – Smiling Mind Pre-School Evaluation
Emma Cameron
Role: 
Honours Student – Calm Kids Study
Erica Allan
Role: 
Research Assistant
Prof Gary Freed
Role: 
Honorary Fellow
Gabriella King
Role: 
Honours Student – CAP
Dr Gehan Roberts
Role: 
Senior Research Officer
Hayley Warren
Role: 
Research Assistant
Dr Jane Sheehan
Role: 
Research Officer
Joanna Meagher
Role: 
Honours Student – Calm Kids Study
Jeremy Quek
Role: 
Postdoctoral Fellow
Kate Paton
Role: 
Senior Research Officer
Kate Stephens
Role: 
Research Assistant
Katie Dunlop
Role: 
Research Assistant
Matthew Bisset
Role: 
Research Assistant
Matt How
Role: 
Advanced Trainee
Dr Melissa Mulraney
Role: 
Research Officer
Dr Nardia Zendarski
Role: 
Research Assistant
PJ Patel
Role: 
Research Assistant
Olivia Ng
Role: 
Research Assistant
Prescilla Perera
Role: 
Research Assistant
Rachel O’Loughlin
Role: 
Research Assistant
Rachel Pelly
Role: 
Research Assistant
Rebecca Peat
Role: 
Research Assistant
Sampada Bhide
Role: 
Postdoctoral Fellow
Samantha Neaves
Role: 
MDRP Student - CAP
Shae Rendall
Role: 
Research Assistant
Dr Shaoke Lei
Role: 
Research Assistant
Stephanie Newman
Role: 
Project Assistant
Natasha Hiscock
Role: 
Honours Student – CAP
Cherry Shi
Role: 
Honours Student
Kim Dalziel
Role: 
Health Economist
Li Huang
Lesley Bretherton
Role: 
Research Assistant
Nicola Read
Role: 
Research Assistant
Emma Stephens
Role: 
Research Assistant

Allergy in the Community Trial (ACT) 
The Allergy in the Community Trial aims to determine whether a new model of care for managing food allergies in children can be safely and effectively implemented in the wider community to relieve overwhelmed tertiary paediatric allergy services.

Australian Paediatric Research Network (APRN)  
The APRN is a network of over 500 Australian paediatricians who are keen to contribute to new research that is relevant to both public and private practice.  The network is the first of its kind in Australia. It builds research capacity by involving more clinicians in research activities and enhancing recruitment for community based research projects. Projects include our annual Multi-Topic survey, 5-yearly national 'snapshot' of paediatric practice, Delphi survey to establish paediatrician's research priorities and the Sleeping Sound with ADHD trial.

Baby Business
The Baby Business intervention project provided parents with information about normal infant sleep and cry patterns and strategies to manage these behaviours. Managing sleep and crying with a new baby can be challenging. Baby Business – a guide for parents is a short booklet to help parents to manage baby’s sleeping and crying in the first few months of life. It’s based on the latest research and provides accessible and practical information for parents. A version for maternal and child health nurses was produced for the Victorian Government in early 2014, now there’s a version for parents too. The booklet is available for just $6 per copy (less for bulk orders), plus postage and handling.

Does the treatment of anxiety in children with ADHD improve outcomes? A large-scale randomised controlled trial. (Calm Kids Study - NHMRC project grant) 
The Calm Kids Study is about anxiety in children with Attention Deficit Hyperactivity Disorder (ADHD). A large number of children with ADHD also experience anxiety (25-50%). We know that anxiety in children with ADHD makes daily life harder for children and their families. The study aims to see whether treating anxiety in children with ADHD improves child anxiety, as well as broader child and family functioning. The intervention program we use to treat anxiety involves teaching children and parents what anxiety is, what causes anxiety, and what children and parents can do to lessen anxiety. To know whether this 10-session program helps, we need to compare children who receive the program with children who do not. Children are randomly placed in either the ‘Intervention Group’ or the ‘Usual Care Group’. The study is funded by the Besen Family Trust, the Myer Foundation, and the National Health and Medical Research Council.

Care Closer to Home
The Care Closer to Home study is made possible by MCRI Population Health theme funding. This study aims to map the experiences of families who have been referred to the Royal Children's Hospital's (RCH) developmental paediatric clinics at the Centre for Community Child Health, but who had their referral redirected back to the referrer as they had bypassed a public paediatric service closer to home. This redirection intervention is already part of clinical care, as too many children were waiting for too long on the RCH clinic waiting list. The research team are interested in understanding whether these children and families have been able to access paediatric care closer to home, and will measure, via a computer assisted telephone interview, access to care, time, and cost and other barriers. Data collection is ongoing.

Changing agendas on sleep, treatment and learning in childhood epilepsy (CASTLE) 
Most children with epilepsy have sleep problems and wake in the night. Disturbed sleep in turn reduces learning ability and can also trigger seizures. Parents often get up to check on their child in case s/he is having a seizure, and sometimes sleep with the child because they are worried. This can make the parent very tired the next day and affect their stress and concentration levels. Led by colleagues in the UK, we are adapting an existing sleep behavioural treatment to the sleep problems experienced by parents of children with epilepsy. We are testing how well it works compared to standard treatment in a randomised controlled trial.

Children’s Attention Project (CAP) 
The Children’s Attention Project (CAP) is a longitudinal cohort study looking at the long-term effects of children’s attention and hyperactivity difficulties on children’s behaviour, learning and day-to-day living, as well as their parents’ well-being. Some children in CAP have attention and/or hyperactivity difficulties, others do not. There are 497 families participating in CAP. Families were recruited when children were in their second year of schooling (Grade 1 in 2011 or 2012). We have since completed three follow ups with families (every 18 months) to see how outcomes vary over time between those with and without these difficulties. We also have a neuroimaging sub-project (the Neuroimaging of the Children’s Attention Project; NICAP) which is looking at how the brain develops across childhood into early adolescence.

Caring for Crying Babies
Advice to parents of babies with infant colic (excessive crying) is often conflicting and comes from many sources, including health professionals. This qualitative study is exploring how families of crying infants are managed by emergency department physicians and maternal and child health nurses. It is also discussing with parents how they experience infant colic management by these health professionals.

Digital Sleep App
Behavioural sleep problems are common in children and are associated with poorer behaviour, learning and parent mental health. Our team has developed a suite of sleep intervention strategies and evaluated them in a series of randomised controlled trials. The strategies are effective in reducing child sleep and behaviour problems and poor parent mental health. However, many parents to do have ready access to these interventions and instead find themselves on long waiting lists for specialist help. This digital sleep app aims to change this. Using strategies tested in our trials, we are building an app to help parents to manage sleep problems in children aged 1- 13 years. We aim to see whether use of this app reduces parent need to stay on a waiting list for specialist sleep support, reduces child sleep problems and has flow on effects with improved child behaviour and parent mental health. Costs of the app from the healthcare and family perspective will be recorded.

Irritability
A pilot study to investigate the acceptability and feasibility of a psychological intervention for children referred to the RCH mental health service with severe irritability. The study will also explore the impact of the intervention on child and family outcomes.

Mental Health Services (Towards an evidence-based and equitable mental health system for children in Australia -NHMRC Project grant)
An NHMRC funded study to investigate the mental health service use in Australian children. This study characterises those Australian children with mental health difficulties who are not receiving any treatment or services and documents the types and costs of services amongst those who are receiving treatment. The study focuses on identifying modifiable child, family, and system level factors associated with access to services and variation in treatments provided to children who do access services.

Models of Child Health Appraised (MOCHA)
Models of Child Health Appraised (MOCHA) is an international study which systematically reviewed variation in health systems for children in Europe and Australia with the aim of identifying optimal models of care. The Australian MOCHA study examined systems of care for children with complex mental health conditions. In particular the study considered the interface between primary and secondary/tertiary care including barriers and enablers of support for children with complex mental health conditions using ADHD and autism as exemplars.

Moving Up
The Moving Up study is a prospective cohort study that examines high school transition for adolescents (n=130) with ADHD in the first and third year of high school across three domains of functioning: (1) academic achievement; (2) social-emotional functioning; and (3) school engagement. This study aimed to describe the early high school outcomes for adolescents with ADHD in comparison to benchmarks and normative data and to identify potentially modifiable factors associated with poor transition outcomes.

Sleeping Sound with ADHD Translational Trial
Our first Sleeping Sound with ADHD trial showed that our intervention was able to improve child and family functioning. We are now testing the translation of this program at the population level by training community paediatricians and psychologists in delivering this behavioural sleep intervention to families of children with ADHD and sleep problems.  The trial is taking place in Victoria and Queensland in partnership with the Australian Paediatric Research Network.

Sleeping Sound with Autism (Tailoring a brief sleep intervention for autism: a randomised controlled trial. NHMRC Project grant) 
This randomised controlled trial, led by researchers at Deakin University, aims to adapt our effective sleep interventions for children with ADHD to determine whether similar benefits to child sleep, behaviour, learning and parent mental health can be realised for children with autism and behavioural sleep problems. 

Smiling Mini Minds Study: A pilot RCT
Smiling Mind in partnership with Early Childhood Australia (ECA) have developed a new pre-school mindfulness program called Smiling Mini Minds. Smiling Mind and ECA have asked the Murdoch Children’s Research Institute (MCRI) to evaluate the Smiling Mini Minds program. As part of the evaluation, the study team want to find out how easy / hard it is for educators to run the program within their early learning centre (ELC) room and whether the program makes any difference to children’s emotions, behaviour or sleep. To find this out, the study will compare ELC educators and children that run and receive the program with educators and children who do not. Following baseline data collection, educators will be randomly assigned to either the ‘Program Group’ or the ‘Usual Care Group’. Children will be placed in the group their educator is in. Educator and parent-reported follow-up data collection will occur three and 12 months post randomisation.

Ambulatory care sensitive conditions across Sweden, USA, Canada, Australia and England (SUCA)
This project aims to compare admission rates for paediatric ambulatory care sensitive conditions (ACSC) in 5 different countries which have different health care systems and providers of primary care to determine if : (i) there is a difference in 10 year trends for rates of admission for paediatric ACSC (per 100,000 population) by jurisdiction and (ii) if there are differences in 10 year trends for rates of admission for paediatric ACSC (per 100,000 population) by socioeconomic group across jurisdictions. ACSC's are considered to be an indicator of primary care accessibility and effectiveness. Comparing ACSC admission rates across these five different jurisdictions may enable policy makers and clinicians to better pinpoint how best to provide primary health care, reduce avoidable admissions and create more equitable and effective systems of primary care. The jurisdictions being compared for this project are California-USA, Ontario-Canada, Sweden, England and Victoria-Australia.

Funding: 
  • National Health and Medical Research Council (NHMRC)
  • The Royal Children’s Hospital Foundation
  • Better Care Victoria (Department of Health and Human Services)
  • Safer Care Victoria (Department of Health and Human Services)
  • Besen Trust
  • Myer Foundation
  • Ian Potter Foundation
  • Royal Australasian College of Physicians Foundation
  • Royal Melbourne Institute of Technology (RMIT) Translational Seed Grant
  • MCRI Population Health Theme Funding
Collaborations: 

National

  • Royal Children’s Hospital, Health Services Research Unit
  • University of Melbourne, Department of Paediatrics
  • University of Melbourne, Centre for Health Policy, Health Economics Unit
  • University of Melbourne, Health and Biomedical Informatics Centre (HaBIC) Research Unit
  • School of Psychology, Deakin University
  • Menzies Kids, University of Sydney
  • Royal Australasian College of Physicians (RACP)
  • Australian Institute of Health Innovation, Macquarie University
  • Sunshine Hospital
  • North Western Melbourne Primary Health Network
  • Werribee Mercy Hospital
  • Curve Tomorrow
  • Monash Children’s Hospital
  • Ballarat Hospital
  • Royal Melbourne Institute of Technology (RMIT)
  • Food & Mood Centre, IMPACT SRC, Deakin University
  • The Australian Centre for Ecogenomics, The University of Queensland

International

  • University of Michigan, Child Health Evaluation and Research Center, Michigan, USA
  • Stanford University, California, USA
  • Toronto Sick Kids, Ontario Canada
  • Trinity College, Dublin, Ireland
  • King’s College, London, UK
  • University College, London, UK
  • Karolinska Institute, Sweden
  • University of Southern Denmark, Centre for Global Health, Denmark