Developmental Diagnostic assessment for children suspected to have developmental disabilities. An interdisciplinary model of care

Abstract

Introduction: A comprehensive developmental diagnostic assessment (DDA) is recommended for children suspected to have a developmental disability to confirm the presence of the primary condition and assess for related health conditions, including aetiology, and develop a management plan. Parents usually have a range of questions and needs that arise from their concern about their child's difficulties, about their experience of and recommendations for DDA and intervention and justifiably expect these to be addressed. Person centred care is the primary ethical concern when working with populations at risk, challenging clinicians to embed this into their models of care and systemic service planning issues. International guidelines recommend that this process involves a team and yet there is little discussion about different models of team assessments. We describe an interdisciplinary model of team based assessment involving social worker, clinical neuropsychologist and paediatrician and the theoretical, enablers and experience of this model of care. Short description of practice change implemented: Each discipline is involved in the full assessment, recognising the importance of collaboration and a interdisciplinary DDA approach. Each clinician retains discipline specific clinical responsibility, but collaborates throughout DDA and development of management plan. Involvement of the social worker specifically facilitates consideration of the social context and social consequence of a disability diagnosis. Aim and theory of change: The aim of this model of care is to more effectively and seamlessly embed person centred care in the diagnostic assessment process by integrating comprehensive psychometric assessments, paediatric diagnostic assessment and systematised parent support before, during and after the assessment. The theories, context and goals of the disciplines will be described as well as the experience of the individuals involved in this team based assessment. Impact for the parents as well as their issues and concerns that arise will be highlighted. Targeted population and stakeholders: Children suspected to have a developmental disability is the primary target population for this team, however, an interdisciplinary model of team based assessment and management may be suitable for a range of vulnerable populations with complex health or developmental concerns. Key stakeholders include parents, referrers, other service providers and the health service funding bodies who balance health outcomes with health service investment. Comments on sustainability: Interdisciplinary models of care can be perceived to be expensive in a system where health service funding favours occasions of service. Limited evidence about the impact of different models of care can bias service provision towards a single discipline or fragmented care via multiple disciplines. Comments on transferability: This interdisciplinary model of DDA can be implemented in a range of health contexts in which these disciplines, knowledge and theories are well established. It is a viable model that may better address the complexities involved in diagnostic assessments and elevate the experiences and needs of parents through that critical period. Further research is necessary to understand the barriers, enablers and impact of different models of care for young children with developmental disabilities and their parents.