Illustrative quotations from participants
| Quote 1 | “The problem is that you can't define it [DAH] I think easily (…) So it's very, very difficult as you can see from me trying to explain”. (HP 1, paediatric hospital) |
| Quote 2 | “‘I think in this Trust we provide excellent care. But again, we look at the disease specific, or injury specific care”. (HP 2, paediatric hospital) |
| Quote 3 | “How many people mentally assess teenagers and see what stage they are at (…) I don't think we are very good at checking and assessing”. (HP 3, general hospital) |
| Quote 4 | “I don't, I don't know, I've never thought about it [providing health care for young people] in that sense before I suppose”. (MA 1, general hospital) |
| Quote 5 | “When you use that word [DAH] I don't know what it means”. (MA 2, general hospital) |
| Quote 6 | “How do I define developmentally appropriate healthcare? I don't know how I would define it”. (HP 4, paediatric hospital) |
| Quote 7 | “It [DAH] would be some awareness and issues for young people in society and young people as a kind of developmental stage around things like mental health, sexual health and confidentiality, consent, drugs and alcohol, all of those things might be issues for them… Vocational issues…So it's sort of seeing that young person in that wider context I think”. (HP 5, adult hospital) |
| Quote 8 | “[DAH is] a service that looks beyond the physical injury (…) Being aware of the right questions to ask. And to look at the patient's whole journey, rather than just this episode in the patient's journey. I think to provide holistic care for the patient. You have to be aware of the family dynamics, of their social dynamics”. (MA 3, adult hospital) |
| Quote 9 | “It's [the provision of DAH for young people] about responding to their needs (…) and also involving the family or carers or whoever has come with them”. (HP 6, paediatric hospital) |
| Quote 10 | “I think developmentally appropriate healthcare only works when it's within the context of respectful, individualised healthcare anyway (…) and therefore you're always focused on that individual as well as their family”. (MA 4, general hospital) |
| Quote 11 | “The psychosocial [development] impacts on the biological [development] and the biological impacts on the psychosocial”. (HP 7, paediatric hospital) |
| Quote 12 | “Healthcare in the strictest sense, in terms of clinical healthcare, I think that remains unchanged”. (HP 1, paediatric hospital) |
| Quote 13 | “Whether they're clinically, whether they are 2, 12, 22…it makes no difference, you treat… you're there to treat their medical condition”. (HP 8, paediatric hospital) |
| Quote 14 | “You've got to be developmentally appropriate in terms of your communication, in terms of your ability to be seeing, to be listening and to be able to appropriately respond and to acknowledge what their concerns are”. (HP 1, paediatric hospital) |
| Quote 15 | “I don't necessarily think the information is very blanket, it's not always appropriate. I don't think we probably use a lot of the media social networking sites and other things to communicate with the younger person as much as we can”. (MA 6, adult hospital) |
| Quote 16 | “[DAH] is for them to have a defined space that is their defined space where there are nurses and clinicians that understand that they're stepping into an environment that is different to the adult space”. (MA 5, adult hospital) |
| Quote 17 | “I think the mind-set is different. (…) They change their approach to look after someone very elderly who's fairly sudden; it's fairly obvious they're elderly. And so, they all have had lots of training on that. We don't train people [to look after young people]”. (MA 5, adult hospital) |
| Quote 18 | “It never stops changing. That's the challenge. (…) you see one person one time, and then three months’ later (…) some other developmental concern has taken primacy”. (MA 7, general hospital) |
| Quote 19 | “That assessment process is also an honest evaluation with families and with the young person about what they're capable of and what they could be capable of given a bit of a push, a bit more resourcing, a bit of encouragement, a bit of trial and error”. (HP 9, paediatric hospital) |
| Quote 20 | “[DAH is] to deliver care that is developmentally appropriate for each individual person as they're coming in to whether it would be a clinic setting or an inpatient setting, so that's best aimed. You know, if they are developmentally a four year old but they have a body of a fourteen year old, well you have to deal with both the medical side of that and the holistic rest of that side with that young person”. (HP 10, paediatric hospital) |
| Quote 21 | “It feels a bit like a gentle educational role. And you do have to be quite gentle, and to sort of not step on toes really. And to sort of try and highlight those sort of areas that do need exploring”. (HP 11, paediatric hospital) |
| Quote 22 | “The more information that we give to them helps them to develop their own healthcare really, doesn't it? (…) So I would say information giving is a massive thing in the process of development”. (HP 4, paediatric hospital) |
| Quote 23 | “Another part of developmentally appropriate healthcare is that you assist the young person to prepare and plan for the move, so you do that consciously (…) to help them realise and to help them to take responsibility, to some extent, for the move from children's to adult services”. (MA 8, general hospital) |
| Quote 24 | “For a lot of them, we seem to be fostering quite an unhealthy dependence on us. And we've seen that with feedback (…) we've done too much for them. (…) Sometimes, it's very hard to step back and we are fostering that dependence on us as an establishment”. (HP 12, paediatric hospital) |
| Quote 25 | “The integrated nature of that [psychosocial and medical needs] and the interconnectivity of those disciplines [that address psychosocial and medical needs] works most effectively for the holistic needs of those young people when that is joined up (…) where that multidisciplinary working is not just a knot but actually is effective and that there is understanding and respect across the multidisciplinary and security to make referrals across multidisciplinary working”. (HP 13, paediatric hospital) |
| Quote 26 | “It's [joined-up working] within certain specialties (…) where they work across the different sites. And they've got quite clear guidance on what the adult services expect and how they function. But for us, for the general medical patients, there isn't that… some might not even go to an adult provider. They might just go to the GP”. (HP 12, paediatric hospital) |
| Quote 27 | “Whether they are ready developmentally or not, it's sort of an age in this hospital I'm afraid and it always will be, because they have to go by the time they are eighteen regardless”. (HP 14, paediatric hospital) |
HP, health professional; MA, manager.