599RCT of Harti Hauora Tamariki: a holistic family-centred programme for child health and equity

Background In Aotearoa NZ, preventable paediatric admissions and readmissions with diseases of poverty are common, particularly for Māori (Indigenous) children. In response, the Harti Hauora Tamariki (HHT) was developed. This is a multilevel programme of: culturally safe engagement; comprehensive high-quality screening; standardised evidence-based protocols for addressing need(s) and navigation. Methodological innovations are required for a RCT of HHT effectiveness within the context of whānau (family) wellbeing. Methods Approximately 980 children admitted to paediatrics at Waikato Hospital were randomised (with whānau) to HHT or usual care. Measures of effectiveness include: level of unmet need identified; impact of HHT on meeting needs; qualitative assessment of HHT support for health outcomes and whānau satisfaction with care. The primary quantitative endpoint is relative readmission risk. Results Qualitative case studies demonstrate the importance of engagement and the high-trust environment of HHT enabling whānau to reveal needs. Needs are common. Many needs identified (such as food insecurity, lack of resources) are not recognised through standard hospital care. HHT adaptations were required. Quantitative outcome analyses are underway. Conclusions The whole health system has responsibility and ability to improve whānau health promotion, prevention, and wellbeing support. HHT provides a model for action. RCT assessment of HHT needed to be whānau-centred and flexible to match programme evolution and provide evidence for effectiveness. Key messages A family-centred holistic screening programme, with culturally-safe engagement, improves inpatient care and enhances determinants of health. Indigenous leadership and commitment to Indigenous wellbeing and equity facilitates effective programme improvement, within an adaptable RCT framework.