MEDICAL POST
February 28, 2008

Novel Program Uses Interdisciplinary Approach to Treat Kids

Umberto Cellupica and Gerald Friedman

Pediatricians today are facing an escalating demand for early diagnosis in children with disabilities so they can receive appropriate treatment in a timely fashion. This is especially pressing in areas such as autism, where waiting lists for assessments continue to grow. Despite the best efforts to assess children as early as 18 months, lengthy wait lists have not allowed pediatricians to achieve that goal with any consistency.

For the past year, pediatricians from York Central Hospital have been addressing this challenge through involvement with the Children’s Treatment Network. This is a new service delivery model for children with multiple needs and their families in Simcoe County and York Region in Ontario. This unique integrated network model builds on the strengths of more than 40 existing service providers to create a system that provides a single point of contact and plan of care for children and youth from birth to age 19 with physical, developmental and communication needs. York Central Hospital has been a partner since the beginning.

Pediatricians or primary care physicians in Simcoe and York with concerns about a child’s development can contact the network at (866) 377-0286. The network will then build an appropriate team of required health, rehabilitation, mental health and education professionals to perform assessments and collaborate with the physician in creating a single plan of care. Services are co-ordinated on an ongoing basis and a team monitors the child’s progress through all phases of their development. This interprofessional care approach is supported by a shared electronic record that allows all professionals on the child’s team to share clinical notes in real time.

There is a developmental assessment and consultation services team to assess children with developmental challenges. This initiative has allowed the expansion of autism screening programs for community members and the shortening of wait lists from 12 months to as little as three months.

Elias, a 3-year old from Richmond Hill, Ontario with speech and language delay, shows Dr. Cellupica (back left) and Children’s Treatment Network Team members (front left) Fiona Lemieux, Communicative Disorders Assistant and (back right) Megan Rubenstein, Speech Language Pathologist, how the gearation toy works during a therapy session.

The network model ideally mirrors the goal of the Local Health Integration Networks initiative, which is to plan and co-ordinate the delivery of services in a child’s community whenever possible. This has long been an area of weakness for independent physicians, since they typically lack opportunities to interact with other health-care professionals in such an integrated fashion. In addition, multiple referrals often lead to confusion for parents and caregivers. This is a vast improvement over a system that forces parents to navigate through various entry points to gain the services they need.

Having the opportunity and resources to engage in an interdisciplinary local team approach also provides an exciting opportunity for physicians. It allows for more thorough assessments of children with special needs and vastly improves communication between all health-care providers.

Of course, the concept of a co-ordinated, team approach has been available within the confines of a hospital setting such as the Hospital for Sick Children for many years. Once physicians leave the boundaries of an academic health sciences centre, however, there are few opportunities to work in a co-ordinated fashion with an interdisciplinary team. As a result, it is unusual for families to be able to receive interdisciplinary assessments in their own communities.

The Children’s Treatment Network is a unique model that has expanded the interdisciplinary approach to the community level. It has allowed physicians to become more engaged in the assessment and treatment process and do the work they have been unable to manage on their own. Parents no longer have to travel long distances to receive specialized services. More importantly, they no longer have to wait years to get the co-ordinated services they need for their children.

Drs. Umberto Cellupica (FRCPC) and Gerald Friedman (FRCPC) both work in the department of pediatrics at York Central Hospital in Richmond Hill, Ont.