1
|
McLennan JD, Fulford C, Hrycko S, Cobigo V, Tahir M. Service Use Patterns by Children With Down Syndrome in a Canadian Region. Intellect Dev Disabil 2023; 61:79-88. [PMID: 36706005 DOI: 10.1352/1934-9556-61.1.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 10/17/2022] [Indexed: 05/16/2023]
Abstract
Children with Down syndrome require services from different sectors over time to optimize health and development, however, there is little information on longitudinal, cross-sector service use. Parents of children with Down syndrome attending a Canadian children's hospital participated in semistructured interviews covering life-time multiple sector service use. Five key service patterns were identified: (1) primary care physicians playing a circumscribed role; (2) a marked shift in public habilitative service receipt from development agencies in the preschool years to exclusive school delivery after school entry; (3) families obtaining private services to address gaps from public sector services; (4) a prominent role for parents to identify additional services; and (5) service variability as a function of timing and severity of medical comorbidity.
Collapse
Affiliation(s)
- John D McLennan
- John D. McLennan, Department of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Casey Fulford
- Casey Fulford, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sophia Hrycko
- Sophia Hrycko, Children's Hospital of Eastern Ontario & Department of Psychiatry, University of Ottawa, ON, Canada
| | - Virginie Cobigo
- Virginie Cobigo, Children's Hospital of Eastern Ontario & Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Munazza Tahir
- Munazza Tahir, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
2
|
McLennan JD, Bahadur A, Cobigo V, Hrycko S, Fulford C. Cross-sector service use patterns among children with developmental disabilities in a district in Canada. J Appl Res Intellect Disabil 2020; 34:546-555. [PMID: 33070429 DOI: 10.1111/jar.12821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a lack of information about cross-sector service use by children with developmental disabilities despite their need for services from multiple sectors. METHODS Responses to service use questions from a parent-completed survey on school-aged children who attended clinics specific for those with developmental disabilities at a Canadian children's hospital were examined. RESULTS School meetings were the most common of three professional meeting types attended in the last 12 months (64.9%) for the sample of 205 children. Recreational services were the most common of five service types received in the same time period (79.0%). Using ordinal logistic regression models, a higher number of behavioural difficulties was the only variable consistently related to indices of more meeting types (school, physician, other) attended and more service types received (recreation, respite, etc.). CONCLUSIONS The service relationship with behavioural problems, and not socio-demographic variables, is consistent with a needs-based oriented delivery system.
Collapse
Affiliation(s)
- John D McLennan
- Children's Hospital of Eastern Ontario-Research Institute, Ottawa, ON, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Virginie Cobigo
- Children's Hospital of Eastern Ontario-Research Institute, Ottawa, ON, Canada.,School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sophia Hrycko
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Casey Fulford
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| |
Collapse
|
3
|
Potvin LA, Fulford C, Ouellette-Kuntz H, Cobigo V. What adults with intellectual and developmental disabilities say they need to access annual health examinations: System navigation support and person-centred care. Can Fam Physician 2019; 65:S47-S52. [PMID: 31023781 PMCID: PMC6501723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To gain an understanding of the support needs of adults with intellectual and developmental disabilities (IDD) when scheduling, traveling to, and attending annual health examinations (AHEs). DESIGN Qualitative study that is part of a large population-level intervention aiming to increase uptake of AHEs among adults with IDD. SETTING Ontario. PARTICIPANTS A total of 8 men and 5 women with IDD took part in semistructured interviews about their personal experiences related to AHEs. METHODS Thematic analysis was used to examine experiences relating to scheduling, traveling to, and attending AHEs. MAIN FINDINGS Support emerged as the overarching theme. Support included assistance navigating the health care system (assistance scheduling AHEs, reminders to book AHEs, financial assistance, transportation) and person-centred care (respect of privacy and autonomy, communication style, kindness, compassion, rapport with physician, health advocacy, and collaboration). Barriers to this support were also identified (lack of rapport, perception of unfriendliness, perception that the physician is too busy to tend to needs, and perception that the physician did not want to perform AHEs). CONCLUSION For adults with IDD, system navigation support and person-centred care were central to accessing AHEs. In collaboration with informal caregivers, physicians have an important role in reducing barriers to patients accessing this valuable preventive care opportunity. Physicians can fulfil some of the needs disclosed by adults with IDD related to attending AHEs by offering support for scheduling appointments, by linking patients with IDD to resources that facilitate appointment attendance, and by increasing consultation duration.
Collapse
Affiliation(s)
- Lynne A Potvin
- Doctoral student in clinical psychology at the University of Ottawa in Ontario and is also a doula
| | - Casey Fulford
- Doctoral student in clinical psychology at the University of Ottawa
| | - Hélène Ouellette-Kuntz
- Epidemiologist and Professor in the Department of Public Health Sciences and the Department of Psychiatry at Queen's University in Kingston, Ont, Director of the National Epidemiologic Database for the Study of Autism in Canada and the Multidimensional Assessment of Providers and Systems, a project lead within the Health Care Access Research and Developmental Disabilities research program, and Secretary to the International Association for the Scientific Study of Intellectual and Developmental Disabilities
| | - Virginie Cobigo
- Clinical psychologist and Associate Professor in the School of Psychology at the University of Ottawa.
| |
Collapse
|
4
|
Ouellette-Kuntz H, Smith G, Fulford C, Cobigo V. Are we making a difference in primary care for adults with intellectual and developmental disabilities? Rev Panam Salud Publica 2018; 42:e154. [PMID: 31093182 PMCID: PMC6385804 DOI: 10.26633/rpsp.2018.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 08/02/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine the impact of the dissemination of guidelines to physicians and of a population-level health communication intervention on the percentage of adults with intellectual and developmental disabilities (IDD) receiving preventive care through primary care. METHODS Noninstitutionalized adults with IDD in the province of Ontario, Canada, aged 40 to 64 years were matched to Ontarians without such disabilities each fiscal year (FY) from 2003 to 2016. Health administrative data were used to create a composite measure of receipt of recommended preventive primary care. Age-adjusted rates were used to assess trends, and average two-year rate ratios (RRs) and confidence intervals (CIs) were used to evaluate the effectiveness of the interventions. RESULTS The number of adults with IDD identified ranged from 20 030 in FY 2003 to 28 080 in FY 2016. The percentage of adults with IDD receiving recommended preventive primary care ranged from 43.4% in 2003 to 55.7% in 2015. Men with IDD had a 53.7% increase across the 13 years, while women with IDD only had a 30.9% increase. When evaluating the impact of the interventions, men with IDD were 4% more likely (RR: 1.04; 95% CI: 1.02-1.05) to receive recommended primary care in FY 2015 and FY 2016 as compared to FY 2009 and FY 2010; in contrast, women with IDD were 5% less likely (RR: 0.95; 95% CI: 0.93-0.98). A comparable drop was observed among women without IDD. CONCLUSIONS Nearly 45% of adults with IDD in Ontario still do not receive recommended preventive care through primary care. Long-term impacts of the interventions introduced in the province may still occur over time, so ongoing monitoring is warranted. Special attention should be given to the preventive care needs of women with IDD.
Collapse
Affiliation(s)
| | - Glenys Smith
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Casey Fulford
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Virginie Cobigo
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
5
|
Silveira J, Rockman P, Fulford C, Hunter J. [Not Available]. Can Fam Physician 2016; 62:983-990. [PMID: 27965332 PMCID: PMC5154647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objectif Proposer aux médecins de soins primaires une approche novatrice pour la détermination des risques et la prise de décisions cliniques connexes dans la prise en charge de troubles mentaux indifférenciés. Sources de l’information Nous avons procédé à une recherche documentaire dans PubMed, CINAHL, PsycINFO et Google Scholar à l’aide des expressions de recherche suivantes, en anglais : diagnostic uncertainty, diagnosis, risk identification, risk assessment/methods, risk, risk factors, risk management/methods, cognitive biases and psychiatry, decision making, mental disorders/diagnosis, clinical competence, evidence-based medicine, interviews as topic, psychiatry/education, psychiatry/methods, documentation/methods, forensic psychiatry/education, forensic psychiatry/methods, mental disorders/classification, mental disorders/psychology, violence/prevention and control et violence/psychology. Message principal Les troubles mentaux constituent une grande part de la pratique en soins primaires; ils se présentent souvent de manière indifférenciée et ce, pendant de longues périodes. La difficile quête d’un diagnostic peut détourner l’attention de la détermination des risques, parce que nous présumons souvent qu’il faut un diagnostic avant d’amorcer un traitement. Cette situation peut avoir contribué par inadvertance à des événements indésirables. Il faudrait en priorité se concentrer sur les points saillants relatifs aux risques que présente le patient. Cet article propose une approche novatrice pour organiser les renseignements sur le patient afin d’aider à la détermination des risques et à la prise de décisions relativement à la prise en charge des patients souffrant de troubles mentaux indifférenciés. Conclusion Une approche structurée peut aider les médecins à gérer l’incertitude clinique fréquente dans la détermination des risques chez des patients souffrant de troubles mentaux, et à composer avec l’anxiété et les biais cognitifs courants qui influencent la prise de décisions en matière de risques. En se concentrant sur les risques, les déficiences fonctionnelles et les symptômes connexes à l’aide d’un cadre novateur, les médecins peuvent répondre aux besoins immédiats de leurs patients tout en continuant à rechercher un diagnostic précis et à établir un traitement à long terme.
Collapse
Affiliation(s)
- José Silveira
- Professeur agrégé au Département de psychiatrie de l'Université de Toronto, en Ontario, psychiatre en chef au St Joseph's Health Centre, et coprésident du Réseau de collaboration en santé mentale du Collège des médecins de famille de l'Ontario.
| | - Patricia Rockman
- Professeure agrégée au Département de médecine familiale et communautaire, nommée conjointement au Département de psychiatrie de l'Université de Toronto, directrice principale de l'Éducation et des services cliniques au Centre for Mindfulness Studies, et fondatrice du Réseau de collaboration en santé mentale
| | - Casey Fulford
- Candidate au doctorat en psychologie clinique à l'Université d'Ottawa, en Ontario
| | - Jon Hunter
- Professeur agrégé à la Division de consultation-liaison en psychiatrie à l'Université de Toronto et membre fondateur du Réseau de collaboration en santé mentale
| |
Collapse
|
6
|
Silveira J, Rockman P, Fulford C, Hunter J. Approach to risk identification in undifferentiated mental disorders. Can Fam Physician 2016; 62:972-978. [PMID: 27965330 PMCID: PMC5154645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To provide primary care physicians with a novel approach to risk identification and related clinical decision making in the management of undifferentiated mental disorders. SOURCES OF INFORMATION We conducted a review of the literature in PubMed, CINAHL, PsycINFO, and Google Scholar using the search terms diagnostic uncertainty, diagnosis, risk identification, risk assessment/methods, risk, risk factors, risk management/methods, cognitive biases and psychiatry, decision making, mental disorders/diagnosis, clinical competence, evidence-based medicine, interviews as topic, psychiatry/education, psychiatry/methods, documentation/methods, forensic psychiatry/education, forensic psychiatry/methods, mental disorders/classification, mental disorders/psychology, violence/prevention and control, and violence/psychology. MAIN MESSAGE Mental disorders are a large component of practice in primary care and often present in an undifferentiated manner, remaining so for prolonged periods. The challenging search for a diagnosis can divert attention from risk identification, as diagnosis is commonly presumed to be necessary before treatment can begin. This might inadvertently contribute to preventable adverse events. Focusing on salient aspects of the patient presentation related to risk should be prioritized. This article presents a novel approach to organizing patient information to assist risk identification and decision making in the management of patients with undifferentiated mental disorders. CONCLUSION A structured approach can help physicians to manage the clinical uncertainty common to risk identification in patients with mental disorders and cope with the common anxiety and cognitive biases that affect priorities in risk-related decision making. By focusing on risk, functional impairments, and related symptoms using a novel framework, physicians can meet their patients' immediate needs while continuing the search for diagnostic clarity and long-term treatment.
Collapse
Affiliation(s)
- José Silveira
- Associate Professor in the Department of Psychiatry at the University of Toronto in Ontario, Psychiatrist-in-Chief at St Joseph's Health Centre, and Co-chair of the Ontario College of Family Physicians Collaborative Mental Health Network.
| | - Patricia Rockman
- Associate Professor in the Department of Family and Community Medicine, cross-appointed to the Department of Psychiatry, at the University of Toronto, Senior Director of Education and Clinical Services at the Centre for Mindfulness Studies, and Founder of the Collaborative Mental Health Care Network
| | - Casey Fulford
- Doctoral candidate in clinical psychology at the University of Ottawa in Ontario
| | - Jon Hunter
- Associate Professor in the Division of Consultation-Liaison Psychiatry at the University of Toronto and a founding member of the Collaborative Mental Health Care Network
| |
Collapse
|
7
|
Fulford C, Cobigo V. Friendships and Intimate Relationships among People with Intellectual Disabilities: A Thematic Synthesis. J Appl Res Intellect Disabil 2016; 31:e18-e35. [DOI: 10.1111/jar.12312] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Casey Fulford
- School of Psychology; University of Ottawa; Ottawa ON Canada
| | - Virginie Cobigo
- School of Psychology; University of Ottawa; Ottawa ON Canada
| |
Collapse
|