An integrated, stepped care organizational model for diagnostic evaluations along the care trajectory of children with a developmental disorder.

Abstract

Introduction: The field of multidisciplinary diagnostic evaluations for children with a developmental disorder in Flanders, Belgium, is heterogeneous and characterized by severe accessibility problems. However, children with a developmental disorder need timely and adequate diagnostics during their trajectory of care and support. This policy support research project develops an organizational model of integrated of care and networking adapted to diagnostic needs in different phases as well as the particularities of the Flemish institutional field. 
 Methods: Homogeneous focus groups were performed with stakeholders from six types of governmental regulated organizations offering specialized diagnostic evaluations in Flanders (Centres for Developmental Disorders, Centres for Ambulatory Rehabilitation, Autism Reference Centres, Mental Healthcare Centres, Pupil Guidance Centres, and Ambulatory Services for Paediatric Psychiatry). A topic list was developed, based on a literature review on relevant themes. Qualitative data was categorized and iteratively compared per theme between focus groups by researcher and data triangulation. A member check validation was organized. 
 Results: 59 experts participated in 6 focus groups. Because of poor participation, the focus group with stakeholders from paediatric psychiatry was cancelled. The focus groups learn that it currently lacks coordination of activities, there is no shared vision on the content and goals diagnostic evaluation, there is an unequal regional distribution of organizations. Interorganizational and interprofessional collaboration is restricted to referral, without integration of care. There is poor mutual trust in the quality of the diagnostic assessments between organizations. Mutual knowledge on activities and expertise, lacks. Regulations hamper interorganizational collaborations as well as different financing mechanisms between organizations. Current organization of the field focuses on organizations’ interests and do not take into account the specific children’s and context’s diagnostic needs during their trajectory.  
 Conclusion: A patient-centred, integrated, stepped care, network model integrating general specialized and highly specialized knowledge and expertise (for different developmental disorders) across organizations borders in a well thought regional approach, is expected by all stakeholders to improve accessibility to specialized diagnostic evaluations adapted to the care trajectory of the child with a developmental disorder.