Dr Teresa Carter Developmental Paediatrician McMaster Children’s Hospital PReschool Pathways and services, need for communication, collaboration, coordination

Objectives What can be done in Primary care Use case examples to illustrate collaboration with community services

Complexity ‘Many parts in an intricate arrangement’ influenced by: Genetics Prenatal environment Specific health needs Physical environment Social environment/cultural environment Learning environment Emotional environment

First approach in primary CARE Promote play Refer to Universal Services

Case 1 18 month old boy 2-3 words, not imitating gestures 3-4 temper tantrums per day Fussy when they visit the mall Likes to watch the same DVDs and listen to the same books Mum is very stressed and cannot cope They feel as if their son rules the

Case 2 18 month old boy Walking since 14 month Unable to get up from sitting Did not mobilise prior to walking Picky eater since 15 months, losing weight Severe distress in grocery store very distressed visiting others homes

Case 3 18 month old girl No words, points and babbles Knows several body parts Easily follows a one step command Crawls, not taking weight on her feet Has a fine pincer grasp and holds a spoon

Case 4 Team Assessment Girl, 18 months Severe delays Hypotonic FTT & major feeding challenges Concerns about vision ESL

Care Pathways Down Syndrome – Health supervision guidelines AAP 2001 Williams Syndrome AAP 2001 – growth charts Angelman – become overweight at adolescence There is no care pathway for ASD, yet! http://www.ncbi.nlm.nih.gov/sites/GeneTests/?db=GeneTests

Conclusion Children with Complex needs should be linked to community based services as soon as possible We need to improve communication and collaboration between community services and primary care Dr R will be talking about Family centred care and it is true particularly for children with rare conditions that their parents do become the expert in the condition as well as the expert in their own child. We should use that expertise to provide their support