85 Improving children and families healthcare experiences through a Community Social Paediatrics model

Abstract

Abstract Background The clinical presentation of children with referrals related for behavioral and school difficulties is often complex and involves environmental and psychosocial components in addition to medical considerations. Collaborative, team based, holistic and integrated approaches are standard of care for many medically complex conditions but less emphasized for what is considered more general presentations in Paediatrics. Given the complexity of patients presenting with challenging behaviors, an integrated approach should be considered as a patient centered and efficient model of care. Objectives The aim of this study was to determine if using a Community Social Paediatrics (CSP) model with an interdisciplinary team can improve experiences and outcomes for families of children being assessed for challenging behaviors who also have complex psychosocial considerations. Design/Methods This pre-post study recruited families with children who had received behaviour-related Paediatric referrals. Participants received the standard of care and additional resources typical to a CSP model, including support from a social worker, home visits, and referral/funding for clinically indicated therapeutic services such as occupational therapy. Three measures were used to evaluate the experience and outcomes of patients and families prior to intake and after 12 months of care: Paediatric Integrated Care Survey (PICS), Child Behaviour Checklist (CBCL), and Quality of Relationship Inventory (QRI). Descriptive analyses of demographics and subscale scores were conducted. Paired t-tests were conducted to detect significant changes in subscale scores across time points. Results In total, 31 caregivers completed the intake assessment and 26 of these completed the follow-up assessment for their children, who were between the ages of 5 to 14 at the time of intake. The QRI scores, which assessed the child-caregiver relationship, indicated a significant decrease in the conflict subscale between timepoints (M1=2.23, M2=1.87, p<0.005). Similarly, the CBCL scores indicated significant reductions in aggressive behaviour (M1= 68.65, M2= 64.77, p<0.05) and conduct problems (M1= 68.69, M2= 62.31, p<0.05). The PICS scores indicated families reported fewer access problems (M1= 3.35, M2= 1.19, p<0.005), and better communication with health care providers (M1= 14.53, M2= 16.92, p<0.05). Conclusion Findings indicate that aspects of the family experience and child outcomes were significantly improved after receiving care through the CSP model. In particular, the reduction of caregiver-child conflict, aggressive behaviour, and conduct problems may indicate that the child’s needs are being more effectively met, thus reducing conflict at home and school. Paediatricians should strongly consider an interdisciplinary model when seeing children for behavioral referrals. This may be especially true for those with complex psychosocial needs.