Situations critiques : une approche clinique spécifique est nécessaire

Abstract

In November 2013, French health ministry notified a device “critical situations” to compensate for the situations “with no solutions” of welcoming and caring for persons disabilities. The existing specialized already saturated devices (for rare diseases, rare handicaps, autism) not being able to assure them, existing institutions were endowed with additional ways to answer these emergencies. In Nîmes (France), a team of Medical Educational Institute (MEI) welcomed, from 2013 to 2015, 12 “Critical situations”. The families’ disturbances intensity imposed creation of a new device: the transitional unity. First, we describe all the peculiarities of social isolation impacts and the need of care for families and children: their confinements at home, the stopping of the educational project, the installation of negative parental representations on the child, couples who isolated themselves socially, and sibling great difficulties. For the disabled child, preexisting disabilities got more complicated or deteriorated. With family adaptation came along relational handicaps (tyrannical/powerful child, attachment disorders: insecure, avoiding or ambivalent). It is difficult to discriminate what returned to the appropriate child disorder, or to the lack of care, expressed with the effects of family adaptations. We explain then the necessity of developing a specific device to restore parents confidence in the system of care and accompany this confined child: 1 – not to neglect course of parents and child during all this period, to collect it, to understand and to recognize the efforts of parent's adaptation, to estimate their capacity to get loose from it; 2 – to individualize the child welcoming, to sequence his activities, resting on the experiment of the parents and on what he can bear of a new frame; 3 – to accompany the child home and modify interactions between him and his family. This device implies an individual frame for the child and a personalized support by the teams until he can benefit from the more classic care in the MEI group.