title: Care closer to home for children and young people who are ill: developing and testing a model of service delivery and organization.
abstract: OBJECTIVE
  To report findings of a national survey of care closer to home services for children and young people and a typology based on these findings.
  
  
  BACKGROUND
  Providing care closer to home for children is a policy and practice aspiration internationally. While the main model of such services is children's community nursing, other models have also developed. Past research has proposed a relatively static typology of services, determined by where they are based, whether they are generic or specialist and whether they provide short- or longer-term input. As services develop, however, this typology needs further elaboration.
  
  
  METHODS
  A two-stage national survey of all primary care and hospital trusts in England, in mid-2008.
  
  
  RESULTS
  In all, 67% of trusts responded to the screening questionnaire and 75% of relevant services to the main stage questionnaire. Thirteen distinct types of services were identified initially. Cluster analysis of delivery and organization characteristics then identified a three-model typology: hospital-based, condition-specific services (36%); children's community nurses and other community services (45%) and other (mainly therapy-based) services (19%). The models differed in staffing, costs, functions, type of care provided and geographical coverage. Only a third of nurses in teams were paediatric-trained.
  
  
  CONCLUSIONS
  Care closer to home services are an established part of care for children and young people who are ill. They deal with complex and technical care and can prevent or reduce the length of acute hospital admission. Lack of readily available information about caseloads, case mix and costs may hamper their further development.
authors.affiliation: Research Unit, University of York, UK. gillian.parker@york.ac.uk
authors.forename: Gillian
authors.initials: G
authors.lastname: Parker
authors.forename: Gemma
authors.initials: G
authors.lastname: Spiers
authors.forename: Linda
authors.initials: L
authors.lastname: Cusworth
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Birks
authors.forename: Kate
authors.initials: K
authors.lastname: Gridley
authors.forename: Suzanne
authors.initials: S
authors.lastname: Mukherjee
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration*; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D003153:Community Health Services / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D004739:England; D005843:Geography; D006699:Home Care Services; D006801:Humans; D017146:Models, Organizational; D009732:Nursing Care / Q000458:organization & administration*; D010371:Pediatric Nursing / Q000458:organization & administration*; D011320:Primary Health Care; D011795:Surveys and Questionnaires