Background: Developmental and behavioural issues in children are increasing in prevalence in primary care practice settings, although family physicians report only fair to low perceived ability to manage children and families with developmental concerns. A Developmental Outreach Clinic was created at our inner city urban hospital, creating a shared care model between family health teams (FHTs), Pediatricians, and Developmental Pediatricians. This was designed to meet the needs of families of children with developmental disorders, many of whom experience unique barriers to care.
Objectives: The primary objective of this study was to determine the feasibility of the Developmental Outreach Clinic and its impact on perceived ability to manage developmental concerns and access to Developmental Pediatricians within the FHTs. This study will help determine the most effective model of care.
Methods: In this qualitative study, a mixed method design was used including semi-structured focus group interviews and administration of a two-item Likert scale questionnaire regarding confidence in management of children with developmental concerns and access to Developmental Pediatricians. Interviews were conducted at each of the FHT sites affiliated with the hospital, as well as at FHTs that serve in the same region without access to the shared care model. All FHT healthcare professionals at each site were invited to participate.
Results: A total of eight practices participated (six affiliated, two non-affiliated), including 63 participants (family physicians n=34, resident/medical student n=7, nurse n=15, other health professional n=7). Participants ranged from 4-20 at each site. While experiences varied between sites, most participants had some experiences caring for a child with developmental concerns. Key themes identified included: no specific developmental training; poor access to, and understanding of, community services (e.g. speech language therapy, applied behavioural analysis therapy); and difficulties with follow up and longitudinal care. Participants from hospital-affiliated FHTs were comfortable referring to Pediatrics for developmental concerns and felt they have improved access to pediatrics, although the referral pathway more specifically to Developmental Pediatricians was not well understood.
Conclusion: The new shared care model is feasible, and there is a perceived improved access for assessment of children with developmental concerns. However, more assistance is needed in the longitudinal care of these families. Building capacity among FHTs in the longitudinal care of these children is a key need identified for our Developmental Outreach Clinic.
