Effective Collaboration Between Home and Community Care Support Services and Complex Care for Kids Ontario

Issue 6 | April 2024

The Provincial Council for Maternal and Child Health (PCMCH) and Home and Community Care Support Services (HCCSS) have partnered together to release the newly developed Practice Guidelines with Recommendations for Effective Collaboration between Home and Community Care Support Services Care Coordinators and Complex Care for Kids Ontario Nurse Practitioners.

Complex Care for Kids Ontario (CCKO) is a provincial program led by PCMCH to improve service delivery, health and quality of life for children/youth with medical complexity (CMC) and their families. CCKO nurse practitioners (NPs) who provide medical care coordination in hospital settings are integral in maintaining strong connections with social support services, including working in concert with HCCSS care coordinators (CCs) to support patients and families in resource and service navigation in the community.

PCMCH and HCCSS convened a working group in June 2023 comprised of representatives from across CCKO and HCCSS to identify opportunities to enhance the partnership between NPs and CCs and develop practice guidelines intended to strengthen, align and standardize the relationship and protocols between the two key providers. Katy Eager, a Nurse Practitioner at London Health Sciences Centre, and also a member of the working group reflected, “this work is important to streamline communication between CCKO and HCCSS, helping to foster the delivery of more seamless care to our complex care families.” The goals of the practice guidelines are to optimize equitable care; enhance patient outcomes and experience; manage expectations and streamline communication; promote complementary and collaborative work; create efficiency in supporting protocols and information exchange; improve provider experience; and demonstrate wise stewardship of limited human resources across multiple sectors.

Karyn Lumsden, Vice President of Patient Services at Home and Community Care Support Services Waterloo Wellington and Co-Chair of the working group, expressed that “these guidelines support integration at the point of care, and we expect to see more fluid sharing of relevant information, improved shared care planning in a way that better supports families and their children, providing reassurance that all members of their care team are on the same page.”

The guidelines, released in March 2024, consist of four practice recommendations and supplementary materials to ensure their successful adoption.


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