Background The Department of Health recently offered funding to support children's palliative care projects, one of which addressed the provision of psychology services within specific children's hospices. The aims of the project were to review best practice in the current provision of psychological support for children with palliative care needs and their families, identify methods of assessing need and evaluating outcomes, and determine how psychological services might link with and enhance the model of supportive care already provided by the hospices.

Methods A mixed methods approach was adopted, involving focus groups with family members and hospice staff, individual face-to-face or telephone interviews with family members, hospice staff and external staff and a web-based survey for parents. Topics covered included the assessment of psychological need and how need is met, the provision of specialist services and any gaps in provision, and the use of assessment and outcome measures. Interviews were recorded and transcribed verbatim and analysed using thematic coding.

Results Ninety-five hospice staff, 28 external staff and 74 family members participated. All staff currently provide psychological support at level 1 (NICE 2004), some provide support at levels 2–3 but there is no provision at level 4. However, there is an untapped and unrecognised resource of existing staff skills within the hospices. Validated tools are not used for assessment or evaluation and some concerns were raised about the mechanisms for families and staff to provide open and honest feedback. Particular areas of need for specialist intervention included the management of challenging behaviour and supervision for staff managing complex situations.

Conclusion Provision of specialist psychology services would be of benefit to the hospices, their patients and families, and external staff. Such a role needs to be embedded in a systemic model of working and have strong links with other professional groups.