Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
Persistent pain affects one in five children, but many Queensland families face significant barriers to accessing timely and appropriate treatment. To support better care in Queensland, we codesigned a new approach.
Dates: 1 January 2024 - June 2025
Implementation sites: Queensland statewide
Partnerships: North Queensland Persistent Pain Management Service
This project was presented as a poster at CEQ Showcase 2026 (PDF 197KB).
Aim
We aimed to:
(1) define needs and implement a sustainable model of care across Cairns, Townsville, and Mackay,
(2) enable children and young people in North Queensland to access high-quality, integrated pain care closer to home.
Outcomes
Key value-based health care outcomes included:
- A threefold increase in sites and a doubling of staff routinely engaged in paediatric pain care in North Queensland.
- Increased access for paediatric patients to timely and integrated care closer to home. Waiting times and overall health care costs reduced.
- Reduction in onward referrals from North Queensland Persistent Pain Management Service (NQPPMS) to QIPPPS reflecting the improved capability to manage complex care locally
- Patients and families reporting satisfaction with access to integrated care closer to home
- High acceptability of both the model of care and the codesign process among staff.
- Perceived improvements in quality of care and stronger inter-service collaboration - collaboration contributed to increased clinical confidence and work satisfaction
Background
One in five young people experience persistent pain (Chambers et al. 2024), but Queensland Interdisciplinary Paediatric Persistent Pain Service (QIPPPS) is the only dedicated paediatric persistent pain service in Queensland. Children may be able to receive appropriate care in regional sites, reducing the load on families to travel to Brisbane for specialist treatment. However, these sites (such as North Queensland Persistent Pain Management Service) have identified that providing paediatric care for persistent pain can have different complexities to treating adults with persistent pain. Further, through a preliminary value-based health care exploration of patient needs and identified high value outcomes, consumers and their families identified a hope for the services in their regions to be better supported to provide the care that they needed, closer to their home.
Methods
We used codesign to develop and implement a developmentally sensitive, family-centred, and formulation driven model of care to deliver paediatric persistent pain care closer to home for children in North Queensland. We embedded a process evaluation to assess feasibility outcomes.
Our participants were the three sites of NQPPMS - Townsville, Cairns and Mackay.
Implementation development and establishment involved three stages: codesigning and implementing the model of care, planning for sustainability, and implementing a sustainability/maintenance plan.
In phase 1, we used codesign to engage stakeholders to inform and adapt the model. The intention of this approach was to build the relationship between QIPPPS and NQPPMS through in-depth needs exploration and to support equality in decision-making and ownership of the model of care. Practical engagement methods included face to face visits, individual online meetings, adhoc phone calls, steering committee meetings, and codesign workshops. Formal data collection (surveys and interviews) further informed the adaptation of the model at key time points, and allowed for evaluation of the codesign process. The model created centred on provision of peer supervision, and co-consultations for patients, to ensure that patients in North Queensland requiring input from QIPPPS could continue to be seen closer to home.
Phase 2 involved planning for sustainability, whereby we identified the key behaviour for change from the needs analysis data; compiled barriers and facilitators for engaging in the key behaviour for change and mapped them to the Capability, Opportunity and Motivation Behaviour change (COM-B) model; used the Centre for Implementation science toolkits to map barriers and identify potential strategies for sustainability, and conducted sustainability codesign workshops to prioritise strategies.
Discussion
The codesigned model of care between QIPPPS and NQPPMS demonstrates how collaborative partnerships can improve access to timely, integrated paediatric persistent pain care closer to home. Reflexive thematic analysis highlighted that optimal collaboration is underpinned by a shared vision for paediatric care and upheld through core philosophies of partnership, flexibility, and mutual respect. These philosophies created a foundation for sustained collaboration, enabling the model to adapt to local needs and contexts.
Staff feedback during interviews confirmed the acceptability of both the codesign process and the resulting model of care. Engaging clinicians early and meaningfully fostered ownership and supported the flexible, context-specific development of shared processes. Face to face contact throughout the project, supported through project funding underspends dedicated to travel and being awarded two AHPEP placements was key to acceptability of the model. These findings echo implementation literature that recognises the importance of codesign, local ownership, and relational trust in driving successful system change.
Implementation of the model has led to tangible improvements in access and service delivery. Compared to baseline, there are now three times the number of sites and 100% more staff involved in delivering regular paediatric persistent pain care across North Queensland. NQPPMS staff reported improved quality of care, increased confidence, and a greater sense of role clarity, indicating that the model is both acceptable and feasible in practice. Parents and carers have reported satisfaction with receiving care in their local environment, feeling that what they have received has been developmentally sensitive and responsive to family needs. The staff in NQPPMS have reported that while they were previously able to sustainably provide care to low-moderately complex paediatric patients, they have capacity to manage increasing complexity, with the multiple avenues of support from QIPPPS now available to them in a streamlined fashion.
Importantly, the model's reach has grown without dedicated increases in staffing, underscoring the strength of its structure but also surfacing potential risks. For example, NQPPMS staff reported a rise in paediatric referrals since implementation'from an average of 37 (2019'2024) to 52 referrals in 2024'2025'which has required adjustments to their service model. This increased demand may negatively impact access. Staff have raised concerns about sustainability without additional resourcing, particularly regarding their capacity to manage both adult and paediatric referrals across a wide geographic area.
There are also equity considerations. While the model has made significant strides in regional access, more work is required to understand and address the specific needs and experiences of Aboriginal and Torres Strait Islander families.
Beyond pain services, the model and framework developed through this project have broader applicability. Collaborations with services like CYMHS or community-based providers could be tailored using existing strategies. These strategies not only meet identified needs but may also uncover new opportunities for collaboration. This proactive approach to identifying and supporting emerging partnerships is a promising avenue for expanding integrated value-based care across Queensland.
References
Chambers CT, Dol J, Tutelman PR, et al. The prevalence of chronic pain in children and adolescents: a systematic review update and meta-analysis. Pain. May 15 2024;doi:10.1097/j.pain.0000000000003267
Eccleston C, Fisher E, Howard RF, et al. Delivering transformative action in paediatric pain: a Lancet Child & Adolescent Health Commission. Lancet Child Adolesc Health. Jan 2021;5(1):47-87. doi:10.1016/s2352-4642(20)30277-7
Hulscher M, Wensing M. Process Evaluation of Implementation Strategies. Improving Patient Care. 2020:369-387.
Grindell C, Coates E, Croot L, O'Cathain A. The use of co-production, codesign and co-creation to mobilise knowledge in the management of health conditions: a systematic review. BMC Health Services Research. 2022;22(1):877.
Atkins L, Francis J, Islam R, et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implementation science. 2017;12:1-18.
French SD, Green SE, O'Connor DA, et al. Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implementation Science. 2012/04/24 2012;7(1):38. doi:10.1186/1748-5908-7-38
Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implementation Science. 2013/12/01 2013;8(1):139. doi:10.1186/1748-5908-8-139
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Braun V, Clarke V. What can "thematic analysis" offer health and wellbeing researchers? International journal of qualitative studies on health and well-being. 2014;9(1):26152-26152. doi:10.3402/qhw.v9.26152
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Key contact
Dr Eloise Cowie
Senior Clinical Psychologist
Children's Health Queensland