A Multidisciplinary Approach to the Assessment and Management of Pre-school Age Neuro-developmental Disorders: A Local Experience

Interorganisational collaboration to improve accessibility of diagnostic evaluations for children with a developmental disability

Introduction

A timely integrated diagnostic and care trajectory for children with a developmental disability may prevent severe problems in later life. In Flanders, Belgium, different types of governmental regulated and subsidised settings offer diagnostic evaluations, as (part of) their mission. However, they operate in a non-coordinated way inducing severe accessibility problems for the public. This article studies the factors impacting on interorganisational collaboration and proposes an interorganisational conceptual model improving accessibility.

Methods

Focus groups were performed per type of organisation. Qualitative data were categorised thematically in an iterative process of data- and researcher triangulation. A member check validation was organised.

Results

Fifty-nine individuals participated in 6 focus groups. Structural and agency-related barriers for interorganisational collaboration were identified at micro, meso and macro level. Participants provided suggestions for better interorganisational collaboration.

Discussion

To improve accessibility adapted to patients' needs, a patient-centred, integrated and interorganisational network model grounded in a stepped care logic is proposed to adapt the current organisation-centred model.

Conclusion

A timely, integrated, diagnostic and care trajectory for children with a developmental disability preventing severe problems in later life requires an integration of services during the overall care trajectory of children by means of interorganisational collaboration.

An Integrated Care Strategy for Pre-schoolers with Suspected Developmental Disorders: The Optimus Co-design Project that has Made it to Regular Care

Introduction:

Multiple neurodevelopmental problems affect 7–8% of children and require evaluation by more than one profession, posing a challenge to care systems.

Description:

The local problem comprised distressed parents, diagnostic processes averaging 36 months and 28 visits with 42% of children >4 years at referral to adequate services, and no routines for patient involvement. The co-design project was developed through a series of workshops using standard quality improvement methodology, where representatives of all services, as well as parents participated.

The resulting integrated care model comprises a team of professionals who evaluate the child during an average of 5.4 appointments (N = 95), taking 4.8 weeks. Parents were satisfied with the holistic service model and 70% of children were under 4 at referral (p < 0.05). While 75% of children were referred, 25% required further follow-up by the team.

Discussion:

The Optimus model has elements of vertical, clinical and service integration. Reasons for success included leadership support, buy-in from the different organisations, careful process management, a team co-ordinator, and insistent user involvement.

Conclusion:

Evaluating multiple neurodevelopmental problems in children requires an integrated care approach. The Optimus care model is a relevant showcase for how people-initiated integrated care reforms can make it into usual care.