When diagnostic assessments of children are entrusted to local teams

2023-11-29 13:03:48

“Acting early” with children is the leitmotif of the Minister responsible for Social Services, Lionel Carmant, but it is also a program that is transforming the practices of the health network. The CIUSSS du Centre-Sud-de-l’Île-de-Montréal has become the first establishment to deploy the new proximity diagnostic trajectory for children with special needs.

After taking the time to implement its new service corridor over the past year, then testing its formula as part of a pilot project last summer, the CIUSSS officially adopted this trajectory since September. It is particularly aimed at children in whom a neurodevelopmental problem is suspected.

All other CISSSs and CIUSSSs in Quebec will have to follow suit by developing a similar service offering in their territory. This is a requirement of the Ministry of Health and Social Services which is part of the “Act Early” program, which Minister Carmant particularly cherishes.

“I went into politics for that!” », recalls the man who practiced as a pediatric neurologist before being elected deputy for Taillon. Even before sitting in the National Assembly, Lionel Carmant campaigned for intervention with children before focusing on their diagnosis. In the network, “people didn’t think it was possible,” he remembers.

“The network saw it as too big a paradigm shift, but we did it one piece at a time,” explains the minister. The government first ensured that additional resources were added to the network. Then, we developed the online assessment platform to report cases of children with special needs. Now, we are working to establish diagnostic trajectories.

“(The CIUSSS) Centre-Sud is one of our leaders. They are the first to do it so effectively and I congratulate them for that,” mentioned the minister in an interview with The Canadian Press.

One team per child

To summarize the concept, a professional identifies what he perceives as a possible developmental disorder in a child aged 0 to 7 years. This could be, for example, a nurse during a vaccination appointment, an educator or a family doctor. This professional then registers the child on the “Act early” platform.

In the past, such a file would have been sent to a tertiary center specializing in pediatrics, such as the CHU Sainte-Justine, the Montreal Children’s Hospital or the university centers of Laval or Sherbrooke. The child and his family would have had to wait several months, or even a year or two, before meeting with a series of specialists, then obtaining a diagnosis and finally receiving services in his region. It was then often very late or too late.

In order to reduce delays, gain efficiency and above all better serve children, the request must be handled by its local establishment. Interventions are then quickly deployed to meet the immediate needs of the young user. He will be seen by the specialist responding to the main need identified.

This professional will become the pivotal worker for the child and a multidisciplinary team will support him. Each team of three to six professionals is modulated according to the needs of the child. If the problem persists and it is deemed necessary to obtain a true diagnosis, it is this same multidisciplinary team that will take care of it.

“That’s what’s new. We dedicated professionals to diagnostic assessments,” underlines the coordinator of early childhood programs and local services at the CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Annick Rajotte.

Concretely, we mobilized speech therapists, occupational therapists, social workers, pediatricians and neuropsychologists. They work collegially to support the child and their family according to their specific needs. Thanks to this new model, “we believe we can complete the entire trajectory in less than three months,” says M.^me Rajotte.

We gain efficiency by only evaluating the child once, by keeping the same speakers and by sharing observations between professionals. We also prioritize cases according to clinical criteria and not only according to the order of reports. In particular, we seek to take action at the right time if a child is preparing to enter CPE or kindergarten.

Benefits

For the D^r Julien Roy-Lavallée, pediatrician, this new procedure already presents benefits since the observations of his colleagues make it possible to have “a 360-degree portrait” of his young patient. He adds that keeping the diagnosis stage within the local team also facilitates the continuity of care given to the child since the same professionals are involved.

Obviously, subspecialized centers will always have a role to play. Moreover, coordination agreements have been made to integrate the CHU Sainte-Justine team into the trajectory of the CIUSSS du Centre-Sud-de-l’Île-de-Montréal if necessary.

However, tertiary centers will eventually be able to focus mainly on more complex or more severe cases, which should reduce their burden.

The ultimate goal is to ensure that every child requiring specialized services can be identified in time and supported so that they are ready to learn when they enter school. We must therefore be patient before evaluating the impact, but Minister Lionel Carmant is hopeful that the academic success of the next generation of students will be greatly improved.

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