title: Managing change in the care of children with complex needs: healthcare providers' perspectives.
abstract: OBJECTIVE
  This paper is a report of a descriptive qualitative study of the role and activities of nursing and allied health professionals caring for children with complex needs in a community setting.
  
  
  BACKGROUND
  Health care is changing in terms of service provision and delivery, with an increased focus on person-centred care, prevention and community-based services. The role of nursing and allied health professionals is central to these changes but is not well described in terms of capacity, or the knowledge and skills required to meet increasing demand.
  
  
  METHODS
  Within four Health Boards, semi-structured telephone interviews were conducted in 2007 with three nursing and four allied health managers, followed by four focus groups with 15 nursing and 11 allied health practitioners; in addition, three nurses and one speech therapist were interviewed by telephone.
  
  
  RESULTS
  Respondents identified challenges related to communication and information systems, equity of service provision, family-centred care and partnership working. Generic and specialized knowledge and skills are needed, although providing the right skills in the right place can often prove problematic with potential implications for service provision.
  
  
  CONCLUSIONS
  Findings support the adoption of integrated partnership working, going beyond the identification of key professionals, to developing a set of criteria against which future service provision could be judged. Research priorities were identified; comparative evaluation of services, better understanding of the transition process and a clearer sense of the individual's response to the increasing customization of services.
authors.affiliation: Institute of Health and Society, School of Education, Communication and Language Sciences, University of Newcastle, Newcastle-upon-Tyne, UK. j.law@ncl.ac.uk
authors.forename: James
authors.initials: J
authors.lastname: Law
authors.forename: Dolly
authors.initials: D
authors.lastname: McCann
authors.forename: Fiona
authors.initials: F
authors.lastname: O'May
mesh_terms: D000293:Adolescent; D000328:Adult; D000488:Allied Health Personnel; D001291:Attitude of Health Personnel; D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000600:supply & distribution; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards; D003266:Continuity of Patient Care / Q000592:standards; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D054625:Healthcare Disparities; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007400:Interprofessional Relations; D024802:Nurse's Role; D015401:Nursing Administration Research; D009739:Nursing Services / Q000458:organization & administration*; D024382:Professional Role; D036301:Qualitative Research; D012606:Scotland; D013222:State Medicine / Q000458:organization & administration; D006113:United Kingdom; D000078329:Workforce